Guide
What does "homebound" mean for Medicare home health?
Short answer
For Medicare home health, "homebound" (the law says "confined to the home") means you meet two criteria. First, because of illness or injury, you need help, a device or special transportation to leave home, or leaving home is medically not advised. Second, you are normally unable to leave home and leaving takes a considerable and taxing effort (CMS Medicare Benefit Policy Manual, Ch. 7, §30.1.1).
Criterion one (meet at least one)
- Because of illness or injury, you need the aid of supportive devices such as crutches, canes, wheelchairs or walkers; special transportation; or the help of another person to leave your home; or
- You have a condition such that leaving home is medically contraindicated.
Criterion two (meet both)
- There is a normal inability to leave home; and
- Leaving home requires a considerable and taxing effort.
Leaving home doesn't automatically disqualify you
The CMS manual says you can still be homebound if absences are infrequent or short, or are to get health care. Examples it gives:
- Health care: adult day centers for medical care, outpatient dialysis, outpatient chemotherapy or radiation.
- Religious services: by law, attending religious services counts as an absence of infrequent or short duration.
- Occasional non-medical trips: an occasional trip to the barber, a walk around the block or a drive, or attending a family reunion, funeral, graduation or other infrequent or unique event.
Being frail because of advanced age is not enough on its own: the manual says an older person who doesn't often leave home because of frailty and insecurity is not considered homebound unless they meet the criteria above.
Who decides
A doctor or allowed practitioner must certify that you are homebound, and your medical record must support it (CMS manual §30.5). HomeCareFinder can't decide whether you qualify. Ask your doctor.
Frequently asked questions
What is the Medicare definition of homebound?
You meet two criteria: (1) because of illness or injury you need a device, special transportation or another person's help to leave home, or leaving home is medically contraindicated; and (2) you are normally unable to leave home and leaving requires a considerable and taxing effort. Source: CMS Medicare Benefit Policy Manual, Ch. 7, §30.1.1.
Can you leave the house and still be homebound for Medicare?
Yes, if absences are for health care (like dialysis or adult day care for medical care), for religious services, or are infrequent or short (like an occasional trip to the barber or a family event). Source: CMS manual §30.1.1 and Medicare.gov.
Who certifies that a patient is homebound?
A physician or allowed practitioner (nurse practitioner, clinical nurse specialist or physician assistant) must certify it. Source: CMS manual §30.1.1 and §30.5.