News Release
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FOR IMMEDIATE RELEASE
Thursday, June 3, 2004 |
Contact: CMS Public Affairs
(202) 690-6145 |
HHS Identifies States for Medicare Demonstration of New, Less Restrictive Homebound Definition
HHS Secretary Tommy G. Thompson today announced the three states
where Medicare will conduct a demonstration project involving a new
definition for homebound that would allow Medicare beneficiaries
receiving home health benefits to leave their home more frequently
and for longer periods without risking the loss of those benefits.
The demonstration in Missouri, Colorado and Massachusetts will mark
an important step in identifying strategies to promote greater
freedom and independence for people with disabilities who require
daily assistance. As part of the three-state demonstration,
which was authorized by the Medicare modernization legislation
enacted last year, Medicare will use a more liberalized definition
of homebound to allow greater mobility to those receiving
home-based services.
“This demonstration will give those with chronically
disabling conditions a chance to live full lives and contribute to
their communities while still receiving services in their
homes,” Secretary Thompson said. “It represents another
step forward in President Bush’s New Freedom Initiative,
which is breaking down barriers to community living for people with
disabilities and addressing the needs of persons with
disabilities. They should not fear that they will lose
home-based services that they depend on just because they try their
best to have lives outside the home.”
Current rules used to determine who qualifies for Medicare payment
of services at home require that any time away from home must be
“infrequent or of short duration.” Congress and
the Centers for Medicare & Medicaid Services (CMS) have refined
this definition in recent years, by clarifying that leaving home
for adult day care or religious services is allowed. The
demonstration project removes a limitation based on actual time
spent away from home, eliminating the concern among many homebound
persons that they will lose their home-based care if they attempt
to take advantage of activities outside the home.
“This evaluation of a less restrictive definition of
homebound for Medicare coverage is an important step toward
achieving our goal of greater freedom and independence for people
with disabilities,” said Mark B. McClellan, M.D., Ph.D.,
administrator of CMS, the agency that oversees the program.
“By eliminating current restrictions, this group of persons
who require substantial daily assistance will have access to more
normal lives in their own communities.”
Up to 15,000 beneficiaries will be eligible to enroll in the
two-year demonstration, which will begin in the fall. To
qualify for the demonstration, Medicare beneficiaries must have a
permanent, severe disability that is not expected to improve.
In addition, the individual must meet each of the following
needs-based criteria:
- Needs permanent help with three of five activities of daily living
(ADLs such as bathing, dressing, eating, toileting and
transferring)
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Needs permanent skilled nursing care, and daily attendant visits to
monitor, treat or provide ADL assistance
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Requires assistance to leave home, and
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Is not working outside the home.
The goal of the demonstration is to determine the cost impact on
the demonstration for patients with chronic illnesses -- a
population that otherwise may be at risk for costly institutional
care. As part of the process of addressing this question, CMS
plans to host an Open Door Forum on June 25 specifically to solicit
input from interested groups to discuss the major features of the
demonstration.
“As we move forward on implementing this important
demonstration program, we will work with home health professionals
and advocates for disabled beneficiaries to make sure we do so
effectively,” Dr. McClellan said. “We need to find the
best, least costly ways to provide more freedom for beneficiaries
with severe disabilities.”
HHS has played a critical role in advancing the New Freedom
Initiative since its launch on Feb.
1, 2001, less than two weeks after President Bush’s
inauguration. To date, about 60,000 people with disabilities
now have Medicaid health coverage through the Ticket to Work and
Work Incentive Improvement Act Medicaid Buy-in Program. HHS
also has approved waivers for nine states that give about 22,000
individuals with disabilities the option to direct their own health
care.
In addition, HHS’ fiscal year 2005 budget plan would
authorize more than $2.2 billion in new spending over the next five
years to build on and expand the President’s New Freedom
Initiative to promote greater independence for Americans of all
ages with a disability or long-term illness.
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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.
Last Revised: June 3, 2004
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