(The following appeared in the November 14, 2002, issue of “Dear Marci,” a free online weekly newsletter from the Medicare Rights Center to keep you in the loop about health care rights, options and benefits for older and disabled Americans.)
 
Dear Marci,
 
My husband is homebound, but he can leave the house to take a short walk around the block or go to church if I help him. The home health agency is saying that he is not homebound. Who is right? 

If he is not considered homebound, could he qualify for Medicare coverage at a Comprehensive Outpatient Rehabilitation Facility?  Also, will Medicare pay for my husband's wheelchair? — Rena (Santa Clarita, CA)
 
Dear Rena,
 
To be considered "homebound," your husband must be generally confined to your home. According to Medicare's definition, leaving the home should require "considerable and taxing effort," and absences from the home for non-medical purposes must be "infrequent or for periods of relatively short duration." These guidelines certainly leave room for interpretation, but in 2000, Congress expanded the homebound definition to allow people like your husband to attend adult day care programs and religious services. (Other exemptions can be found at http://cms.hhs.gov/manuals/11%5Fhha/hh200.asp#sect_204_1.) Therefore, your husband should be eligible to continue receiving coverage from Medicare for his home health care.

• If he is not considered homebound, he could qualify for Medicare coverage at a Comprehensive Outpatient Rehabilitation Facility. Comprehensive Outpatient Rehabilitation Facilities, or CORFs, are facilities that offer diagnostic, therapeutic, and restorative outpatient services that are supervised by a physician. Medicare-covered CORF services are those that would be covered as inpatient hospital services and must be medically necessary for the purposes of diagnosis or treatment of a condition-meaning that services administered as part of a maintenance program that requires skilled nursing or therapist services would not be covered.
  
  
• Under Part B, Medicare will cover your husband's wheelchair since it is considered durable medical equipment. Medicare requires that your husband's condition would leave him otherwise confined to a bed or chair. Remember that he must buy his wheelchair from a Medicare-certified supplier.

— Marci

For more information about Medicare's coverage of home health care, visit the Home Care Channel on the Medicare Rights Center's web site at http://www.medicarerights.org/homecare.html.

Would you like to read more from Dear Marci? To sign up, send an e-mail to mailto:dearmarci@medicarerights.org with the word “subscribe” in the subject line. Have a question for Marci? Write her at mailto:dearmarci@medicarerights.org.

The Medicare Rights Center (MRC) is a national, not-for-profit consumer service organization working to ensure that older adults and people with disabilities receive high-quality, affordable health care. MRC answers over 75,000 consumer questions each year. For more information about MRC, visit the web site at http://www.medicarerights.org.

January 2003