Massachusetts Part of Medicare Home Health Pilot

The Centers for Medicare & Medicaid Services (CMS) has implemented the “Medicare Home Health Independence Demonstration”, a 2-year pilot project in 3 states (Massachusetts, Missouri and Colorado) to expand the definition of homebound for purposes of Medicare home health benefits. Normally, Medicare beneficiaries may receive home health benefits as long as they need a skilled service, such as physical therapy or nursing visits, and as long as they leave the home only for such purposes as medical care, religious services or adult day care. The second limitation is now lifted in these states for the through October 3, 2006 or 15,000 patients, whichever comes first.

In addition to meeting all the criteria required for Medicare home health eligibility and coverage, beneficiaries will need to meet ALL of the following conditions:

• The beneficiary has been certified by an attending physician to have a permanent and severe disabling condition that is not expected to improve.
• The beneficiary needs permanent help with at least 3 of 5 activities of daily living (ADLs) (bathing, dressing, eating, toileting, and transferring.)
• The beneficiary needs permanent skilled nursing care (other than medication management), AND daily attendant visits to monitor or treat a medical condition or to provide ADL assistance.
• The beneficiary needs assistance of a person or technological device (e.g., a walker) to leave home, AND leaving home requires considerable and taxing effort.
• The beneficiary is NOT working regularly in a paid position full-time or part-time outside the home.
• The beneficiary has Part B and does NOT receive Medicare home health services through an HMO, MedicareAdvantage plan or via the hospice benefit.

Eligibility for the demonstration and for the home health services must be re-assessed at least every 60 days.

For further information or assistance, please call Medicare’s implementation contractor, Abt Associates, at 1-888-HHDEMO5 (1-888-443-3665) or e-mail them at homehealthindependence@abtassoc.com. General information for providers, beneficiaries, and other interested parties can be obtained at http://www.cms.hhs.gov/researcers/demos/homehealthindependence.asp or through 1-800-MEDICARE.

The purpose of the demonstration is to study the efficacy and cost to Medicare of providing home health services to Medicare beneficiaries with severe chronic conditions who otherwise would not be deemed homebound under the Medicare program. Under the demonstration, those who qualify will be able to leave their homes more frequently and for longer periods without risking the loss of benefits.

- From ElderLaw NewsFrom Margolis & Associates  December 14, 2004, http://www.cms.hhs.gov/researchers/demos/homehealthindependence.aspand http://www.cms.hhs.gov/researchers/demos/HHAPac10_8_04.pdf