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GAO-02-555R 1 (2002-04-26)

handle is hein.gao/gaobaalys0001 and id is 1 raw text is: i Accountability * Integrity * Reliability United States General Accounting Office Washington, DC 20548 April 26, 2002 Congressional Committees Subject: Medicare Home Health: Clarifying the Homebound Definition Is Likely to Have Little Effect on Costs and Access About 2.5 million Medicare beneficiaries used home health services in 2000 at a cost of $8.7 billion-about 4 percent of Medicare expenditures that year. Medicare's home health benefit provides skilled nursing and other services to beneficiaries who are homebound, that is, able to leave home only with great difficulty and for absences that are infrequent and of short duration.' Based on this statutory requirement, the Department of Health and Human Services (HHS) had a long-standing policy that beneficiaries who regularly attended adult day care were not considered homebound, particularly if the purpose of attending was to receive nonmedical or custodial care. Adult day care centers offer a range of social, medical, and other services to enrollees in a group setting.2 This policy created uncertainty about Medicare home health eligibility for individuals receiving medical services at adult day care centers because of HHS's premise that a homebound beneficiary was unlikely to be able to leave home on a regular basis to seek necessary medical treatment from a center. In December 2000, the Congress specified that attending adult day care would not disqualify Medicare beneficiaries from being considered homebound if they still met the other homebound requirements.4 Specifically, the change provided that a beneficiary's eligibility for home health was not affected by absences from the home 'Permitted absences include obtaining necessary medical care such as physician visits and treatment at a hospital, extended care facility, or rehabilitation center when the required medical equipment is too cumbersome to bring to the beneficiary's home. 2Adult day care is not a Medicare-covered service and Medicare will not pay home health agencies for services delivered in an adult day care center. However, a small amount of Medicare funding supports adult day care through programs such as the Program for All-Inclusive Care for the Elderly, known as PACE. See U.S. General Accounting Office, Medicare and Medicaid: Implementing State Demonstrations for Dual Eligibles Has Proven Challenging, GAO/HEHS-00-94 (Washington, D.C.: Aug. 18, 2000). 3HHS, Homebound: A Criterion for Eligibility for Medicare Home Health Care (Washington, D.C.: Apr. 1999). 4Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act, P.L. 106-554, §507 114 STAT. 2763A-532, 2763A-533 (Dec. 21, 2000). The change became effective on December 21, 2000. GAO-02-555R Medicare Homebound Definition

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