3. Patient must be confined to their home
An individual does not have to be bedridden to be considered as confined to their home. The patient's condition must be such that there exists a normal inability to leave home and, consequently, leaving their home would require a considerable and taxing effort.Generally, a beneficiary is considered to be homebound if they have a condition, due to an illness or injury which restricts their ability to leave their place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person or if they have a condition so that leaving their home is medically contraindicated.
A patient's residence is wherever they make their home. This may be their own dwelling, an apartment, a relative's home, a home for the aged, or some other type of institution. However, an institution may not be considered a patient's residence if it:
a. Meets at least the basic requirement in the definition of a hospital; i.e., it is primarily engaged in providing by or under the supervision of physicians, to inpatients, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, and sick persons, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons or
b. Meets at least the basic requirement in the definition of a skilled nursing facility; i.e., it is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons. Thus, if an individual is a patient in an institution or distinct part of an institution which provides the services described in items a. or b. above, they are not entitled to have payment made for home health services under either Part A or Part B since such an institution may not be considered their residence. When a patient remains in a participating SNF following their discharge from active care, the facility may not be considered their residence for purposes of home health coverage.