[Congressional Record Volume 146, Number 35 (Monday, March 27, 2000)]
[Senate]
[Page S1748]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JEFFORDS (for himself, Mr. Reed, and Mr. Leahy):
  S. 2298. A bill to amend title XVIII of the Social Security Act to 
clarify the definition of homebound with respect to home health 
services under the Medicare Program; to the Committee on Finance.


                    THE HOMEBOUND CLARIFICATION ACT

 Mr. JEFFORDS. Mr. President, I am here today to introduce the 
Homebound Clarification Act of 2000. This important bill has been 
crafted to protect Medicare beneficiaries from a growing problem that 
is impeding access to vital home care services. I want to recognize my 
cosponsors, Senator Reed of Rhode Island and Senator Leahy, for their 
continued effort and dedication to protecting access to home health 
care.
  Federally funded home health care is an often quiet but invaluable 
part of life for America's seniors. Medical treatment can often mean 
being subjected to a strange and unfamiliar environment. For our 
nation's elderly, who may have special needs, this inconvenience can be 
more severe and detrimental to successful recovery. Home health care 
means that people recovering from surgery can go home sooner--it means 
that someone recovering from an accident can get physical therapy in 
their home, it means our seniors can stay at home, and out of nursing 
homes.
  The sooner you can return patients to their homes, the sooner they 
can recover. The familiar environment of the home, family, and friends 
is more nurturing to recovering patients than the often stressful and 
unfamiliar surroundings of a hospital. Home health is also a great 
avenue for education. It empowers families to assist in the care of 
their loved ones. It is smart policy from human and financial 
standpoints.
  But there are some seniors who are being denied access to this smart 
policy. An individual must be considered ``homebound'' to qualify for 
Medicare reimbursement for home health. Though an individual is not 
required to be bed-ridden, the condition of the individual should 
include ``a normal inability to leave the home.'' Under the current 
definition, an individual is ``homebound'' if ``leaving the home 
requires a considerable and taxing effort by the individual, and that 
absences of the individual from home are infrequent and of short 
duration, or are attributable to the need to receive medical 
treatment.'' The definition allows for ``infrequent'' or ``short 
duration,'' recognizing that short excursions may be a part of a 
successful recovery process, but leaves it up to fiscal intermediaries 
to interpret exactly what number is frequent and how short an absence 
must be. Interpretation of this definition has varied widely.
  Sadly, there is a ready supply of disturbing examples of the 
overzealous and arbitrary interpretation of the definition. Many 
seniors have found themselves virtual prisoners in their homes, 
threatened with loss of coverage if they attend adult day care, weekly 
religious services, or even visit family members in the hospital. This 
makes no sense because all of these activities are steps on the road to 
successful and healthy recovery. Often, health professionals want 
patients to get outside for fresh air or exercise, as part of their 
care plan. This helps fight off depression.
  Seniors deserve a more consistent standard to depend upon, rather 
than a completely arbitrary number of absences from the home. In April 
1999, Secretary of Health and Human Services Donna Shalala sent a 
report to Congress on the homebound definition. The report identifies 
the wide variety in interpretation of the definition and the absurdity 
of some coverage determinations that follow. While the Administration 
unfortunately stopped short of taking action themselves, Shalala did 
propose that a clarification of the definition is needed to improve 
uniformity of determination.
  The Homebound Clarification Act states that eligibility of an 
individual depends on the condition of the patient, how ``taxing'' it 
is for the patient to leave home. It strikes the clause that states: 
``that absences of the individual from home are infrequent or of 
relatively short duration, or are attributable to the need to receive 
medical treatment.'' This is consistent with the intent of Congress and 
the Administration. This will not open the door to wider coverage of 
home health, but rather protect coverage for those who need it.
  We ask that seniors put their trust in the Medicare program. We are 
responsible for making sure that the Medicare program lives up to its 
promise and that home health will be available to those who need it. 
Once again, I would like to thank my cosponsors, Senators Reed and 
Leahy for their work. We look forward to working with the rest of 
Congress to turn this legislation into law.
                                 ______