Bipartisan Bill Would Loosen Medicare Home Health Eligibility Restrictions

Reps. Edward Markey (D-Mass.) and Christopher Smith (R-N.J.) have introduced a bill (HR 1490) to redefine the conditions under which disabled Medicare beneficiaries may receive home health benefits. The congressmen say that the current definition "literally forces many home health beneficiaries to become prisoners in their homes" or risk losing their benefits. Current Medicare law requires that home health beneficiaries must be "homebound" and that any absence from the home must be "infrequent and of short duration" among other requirements (Markey release, 5/16). Under the Homebound Clarification Act of 2001, Markey and Smith would remove the "infrequent and of short duration" stipulation in allowing absences from the home for home health beneficiaries, although a "normal inability to leave home" would still have to be demonstrated (HR 1490 bill text). The lawmakers cite the case of David Jayne, a Georgia man who was diagnosed with Lou Gehrig's disease, or amyotrophic lateral sclerosis (ALS), at the age of 27. Now 40, Jayne has used a motorized wheelchair to discuss his disability with young people, health care workers and fellow patients, even "though he can barely move three fingers and cannot breathe or eat on his own," People magazine reported in April. Jayne had been receiving Medicare home health benefits through Healthfield Inc., which sent a home health worker to his home for two hours, four mornings a week, at a monthly cost of $800. Last November, however, Healthfield notified Jayne that because he frequently left his home he no longer fit the definition of "homebound" under Medicare and his benefits would be cut off. Eight days later, Rep. Mac Collins (R-Ga.) "intervened" and got HCFA to restore Jayne's benefits on the condition that he "would repay Healthfield if his appeal" to HCFA was denied. Discussing the Medicare rules, Bob Raubauch, Jayne's attorney, said, "It's an absurdity. Like David, there are quadriplegics and others who need [home health care] just to get out of bed and into their wheelchairs. But once there, these people can conduct their lives" (Charles/Wescott, People, 4/16).

Home Alone No More
Last week, Markey and Smith held a briefing to highlight their legislation, where Markey said, "[W]e are not trying to expand the home health benefit and we are not seeking additional Medicare coverage; we are simply trying to improve the quality of life for individuals who already have the odds stacked against them" (Markey release, 5/16).