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Homebound means that “the patient cannot leave home without excessive effort such as but not limited to requiring the aid of supportive devices (i.e. crutches, canes, wheelchairs, and walkers), the use of special transportation, the assistance of another person, or if he or she has a condition which is such that leaving his or her home is medically contraindicated.” In addition, absences from home must be infrequent, or of short duration, or to get medical attention. Absence from home to attend adult day-care does not negate a patient’s homebound status, nor do occasional absences from the home for non-medical purposes, (for example, an occasional trip to the barber, attending a religious service, a walk around the block, or a drive) so long as they 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, if a patient can be away from the home an average of 16 or more hours per month for non-medical reasons then the homebound criterion would not be met.
A skilled need is a level of care that includes services that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse) or therapist. Examples include pressure ulcer treatment, bladder catheter management, and hypertension or diabetes management requiring frequent checks or medication adjustments. If a patient does not have a nursing need but has a need for other skilled treatment (for example, physical or occupational therapy after an episode of pneumonia treated at home but resulting in a decline in physical functioning after recovery from the acute illness), Medicare will still pay for a homebound patient to receive those services at home.
Medicare will NOT pay for personal care services (also known as home health aide services) in the absence of a skilled need.