Medicare Homebound Criteria

In order for a patient to be eligible to receive covered home health services under both Medicare Part A and Medicare Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home.  An individual does not have to be bedridden to be considered confined to the home.  However, the condition of these patients should be such that there exists a normal inability to leave home, and consequently, leaving the home would require a considerable and taxing effort.

If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment.  Absences attributable to the need to receive health care treatment include, but are not limited to:

                  Attendance at adult day centers to receive medical care

                  Ongoing receipt of outpatient kidney dialysis

                  The receipt of outpatient chemotherapy or radiation therapy

Any absence of an individual from the home attributable to the need to receive health care treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, shall not disqualify an individual from being considered to be confined to his home.  Any other absence of an individual from the home shall not so disqualify an individual if the absence is of an infrequent or of relatively short duration.  For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration.  It is expected that in most instances, absences from the home that occur will be for the purpose of receiving health care treatment.  However, occasional absences from the home for non-medical purposes, e.g., an occasional trip to the barber, a walk around the block or a drive, attendance at a family reunion, funeral, graduation, or other infrequent or unique event would not necessitate a finding that the patient is not homebound if the absences are undertaken on an infrequent basis or are of relatively short duration and do not indicate that the patient has the capacity to obtain the health care provided outside rather than in the home.

Generally speaking, a patient will be considered to be homebound if they have a condition due to an illness or injury that restricts their ability to leave their place of residence except with the aid of:  supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated. 

Click Here for Specific Examples Regarding Homebound Status

For More Information on Homebound Status Criteria, 

Visit www.medicare.gov.