Medicare Bill Would Loosen Home Health 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 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. According to a Markey press release, 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" (Markey release, 5/16). 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 uses 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 were being 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 this service just to get out of bed and into their wheelchairs. But once there, these people can conduct their lives" (Charles/Wescott, People, 4/16).

Last month, Markey and Smith introduced the Homebound Clarification Act of 2001, which would remove the "infrequent and of short duration" stipulation from Medicare law and would allow 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). 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).