Page 90 - Medicare Benefit Policy Manual

In these circumstances, the physician or clinic is expected to assist the patient in
obtaining such skilled services together with the other home health services (such as aide
services). However, HHA services are not considered available where the HHA cannot
respond on a timely basis or where the physician could not have foreseen that intermittent
services would be needed.

Refer to the Medicare Claims Processing Manual, Chapter 10, “Home Health Agency
Billing,” for a more in depth discussion of home health services.

60.4.1 - Definition of Homebound Patient Under the Medicare Home
Health (HH) Benefit
(Rev. 192, Issued: 08-01-14, Effective: 09-02-14, Implementation: 09-02-14)

This definition applies to homebound for purposes of the Medicare home health benefit.

For a patient to be eligible to receive covered home health services, the law requires that
a physician certify in all cases that the patient is confined to his/her home. For purposes
of the statute, an individual shall be considered “confined to the home” (homebound) if
the following two criteria are met:

1. Criteria-One:

The patient must either:

- Because of illness or injury, need the aid of supportive devices such as
crutches, canes, wheelchairs, and walkers; the use of special transportation; or
the assistance of another person in order to leave their place of residence

OR

- Have a condition such that leaving his or her home is medically
contraindicated.

If the patient meets one of the Criteria-One conditions, then the patient must ALSO meet
two additional requirements defined in Criteria-Two below.

2. Criteria-Two:

- There must exist a normal inability to leave home;

AND

- Leaving home must require a considerable and taxing effort.