Page 91 - Medicare Benefit Policy Manual

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; or

• 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, or accredited to furnish adult day-care services in 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 nonmedical 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.
Some examples of homebound patients that illustrate the factors used to determine
whether a homebound condition exists would be:

• A patient paralyzed from a stroke who is confined to a wheelchair or requires the
aid of crutches in order to walk;

• A patient who is blind or senile and requires the assistance of another person in
leaving his or her place of residence;

• A patient who has lost the use of the upper extremities and, therefore, is unable to
open doors, use handrails on stairways, etc., requires the assistance of another
individual to leave his or her place of residence;

• A patient in the late stages of ALS or neurodegenerative disabilities. In
determining whether the patient has the general inability to leave the home and
leaves the home only infrequently or for periods of short duration, it is necessary
to look at the patient’s condition over a period of time rather than for short
periods within the home health stay. For example, a patient may leave the home
(under the conditions described above, e.g., with severe and taxing effort, with the