New Language for Medicare Homebound Restriction
a 'Huge Disappointment' to Reform Activists
by Christina Medvescek
"A hollow victory – a huge disappointment to what we were fighting for."
That's how activist David Jayne describes new language passed by the U.S. House of Representatives amending the Medicare homebound restriction. The new language clarifies the rights of people who receive Medicare home health services, but some believe it might have the effect of further limiting their activities.
The new language is part of the Medicare reform package passed by the House on June 28. The U.S. Senate is scheduled to begin debate on its version of a Medicare reform bill on July 15.
'A Trip to the Barber'
The homebound restriction requires people who receive Medicare home health services (in-home skilled nursing assistance with bathing, feeding and other basic functions) to remain in their homes at all times, except for short and infrequent absences. Jayne, who is almost completely paralyzed by amyotrophic lateral sclerosis (ALS), and who temporarily lost home health services after traveling to a college football game, is the founder of the National Coalition to Amend the Medicare Homebound Restriction for Americans with Significant Illness (NCAHB).
NCAHB seeks to eliminate any restrictions on home absences, pointing out that current technology gives people with disabilities much greater mobility than they had 30 years ago when "homebound" was defined. The organization has garnered support from about 13,000 individuals and 46 organizations, including MDA. Members of the MDA National Task Force on Public Awareness have lobbied Congress to amend the restriction.
The amended language that passed the House isn't what NCAHB had in mind, however. Rather than eliminating restrictions, the new language clarifies that absences "such as an occasional trip to the barber or a walk around the block" are permissible activities and won't result in termination of Medicare home health benefits.
This new language is "a step backwards," according to Rep. Ed Markey (D-Mass.), co-sponsor of the Homebound Clarification Act (H.R. 1490) to eliminate restrictions. David Moulton, Markey's aide, says Markey "vigorously objected to this language" because it appears to narrow permissible absences from the home to "things that take less than an hour."
Rep. Markey had successfully amended the homebound definition in 2000 by getting language included that allows home health beneficiaries to attend adult day care and religious services.
William Altaffer of Tucson, Ariz., a member of the steering committee of the MDA Task Force, notes, "A trip to the barber or a walk around the block will do little to end the isolation or improve the quality of life for homebound Medicare patients. To use a public health policy to further confine persons with disabilities is not a compassionate response."
The Final Round
The amended language came as a surprise to Jayne and Markey, who prior to the vote were optimistic they had sufficient support to have the restrictions greatly eased or eliminated.
Jayne said some legislators have congratulated him for successfully having homebound language included in the House version of the bill, "but I hardly call being allowed to go to the barber shop and walk around the block a success."
The fight isn't over but it's down to the final round for this year, says Jayne, noting that the Senate vote on Medicare reform "is our last opportunity in this Congress for real homebound reform." Jayne plans to go to Washington on July 7 to lobby senators on behalf of NCAHB.
Former Sen. Bob Dole, NCAHB's honorary chairman, feels confident NCAHB will win its case in the Senate, Jayne notes.
Jayne urges supporters to contact their senators immediately about the importance of easing homebound restriction language. For more information, visit www.amendhomeboundpolicy.homestead.com.
