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Homebound Criteria: What does homebound mean?

Medicare requires that a patient be “homebound” to qualify under Medicare for home health nursing and therapy services. Here are some tips to help you decide if your patient meets Medicare requirements:

“Homebound” does NOT mean that a patient has to be “bed bound” to qualify. The patient is considered “homebound” under Medicare if:

  • The patient cannot leave home without “considerable and taxing effort.” Most patients have an injury or illness that makes it difficult to leave home. Examples include (but are not limited to):
    1. Requires the aid of supportive devices,
    2. Requires the use of special transportation,
    3. Needs the assistance of another person,
    4. Has a condition that leaving the home is medically contraindicated.
  • The patient can leave home for medical treatment (such as chemotherapy or dialysis) or for receiving therapeutic and psychosocial treatment (such as through a certified a dult day care program).
  • The patient cannot be disqualified from services if they leave home for a non-medical absence as long as the absence is “infrequent and short in duration”. Some examples include attending a religious service, a trip to the barber, special family event or a walk around the block.

Our central intake staff are trained in assisting referral sources in determining Medicare and other insurance requirements and are a resource to you. Please call our staff if you are unsure if the patient meets requirements or have any questions.

Central Intake Department: 608-241-6900 or 1-800-900-8040

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