medicare/homebound status

[Karen deGraaf <kdegraaf@xxxxxxxxx>]

Robin,
Please give me more information:
Where do you live?  (state)
What are your mother's cousin's symptoms which limit her ability to get out
of the home? (what functional limitations: i.e. she is unable to walk 20 ft
without getting short of breath due to her congestive heart failure)
What is the assisted living facility responsible to offer the cousin?
(personal care for example)
How often does the cousin leave her home and for how long at one time?
(hours and how many days per week)
Does she see her medical doctor and how often?
How does she get to meals at the assisted living home?
What aids facilitate her movement about the home?

All these questions have relevance.  The Medicare "reimbursement agency" has
slightly differing opinions or interpretations  based on where you live, for
example therefore the state question. Sorry, but that is life.
AND YES, Medicare is quite specific on those requirements and homebound is a
HOT BUTTTON for them because they feel that non-homebound patients do not
qualify for Medicare benefits....that is the patient's injury or medical
condition must be  such that he has an INABILITY to leave the home unless
there is considerable and taxing effort.  They don't want a patient to be a
prisoner in his own home, but MC does not want people to do what they
consider fraud.  Home care agencies are very concerned about this.  Thus
your phone call.  I may not have been so quick on that issue but then again
I don't know all the facts.  You and I can discuss it if you care to.

Does that help?   KdG,  RN,   HomeHealth Director of Clinical Operations
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Karen deGraaf
e-mail to:  kdegraaf@xxxxxxxxx