An individual does not have to be bedridden to be considered as confined to his home.
The patient's condition must be such that there exists a normal inability to leave
home and, consequently, leaving his home would require a considerable and taxing effort.Generally,
a beneficiary is considered to be homebound if he has a condition, due to an illness
or injury which restricts his ability to leave his 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 he has a
condition so that leaving his home is medically contraindicated.
A patient's residence is wherever he makes his home. This may be his 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:
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
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, he is 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 his residence.When a patient remains in a participating
SNF following his discharge from active care, the facility may not be considered his
residence for purposes of home health coverage.