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|FOR IMMEDIATE RELEASE
|June 3rd, 2004
||Contact: CMS Public Affairs
HHS Identifies States For Medicare Demonstration
Of New, Less Restrictive Homebound Definition
HHS Secretary Tommy G. Thompson today announced the three states
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
"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
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
- Needs permanent skilled nursing care, and
daily attendant visits to monitor, treat or provide ADL assistance
assistance to leave home, and
- 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
"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.