[Congressional Record Volume 148, Number 108 (Thursday, August 1, 2002)]
[Senate]
[Pages S7913-S7914]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS (for herself, Mr. Cleland, Mr. Hutchinson, Mr. 
        Kerry, Ms. Snowe, and Mr. Miller):
  S. 2848. A bill to amend title XVIII of the Social Security Act to 
provide for a clarification of the definition of homebound for purposes 
of determining eligibility for home health services under the medicare 
program; to the Committee on Finance.
  Ms. COLLINS. Mr. President, I am pleased to join with Senators 
Cleland, Hutchinson, Kerry, Snowe and Miller in introducing the David 
Jayne Medicare Homebound Modernization Act of 2002 to modernize 
Medicare's outdated ``homebound'' requirement that has impeded access 
to needed home health services for many of our nation's elderly and 
disabled Medicare beneficiaries.
  Health care in American has gone full circle. People are spending 
less time in institutions, and recovery and care for patients with 
chronic diseases and conditions has increasingly been taking place in 
the home. The highly skilled and often technically complex care that 
our home health agencies provide have enabled millions of our most 
vulnerable older and disabled individuals to avoid hospitals and 
nursing homes and stay just where they belong, in the comfort and 
security of their own homes.
  Under current law, a Medicare patient must be considered 
``homebound'' if he or she is to be eligible for home health services. 
While an individual is not actually required to be bedridden to qualify 
for benefits, his or her conditions must be such that ``there exists a 
normal inability to leave home.'' The statute does allow for absences 
from the home of ``infrequent'' or ``relatively short duration.'' 
Unfortunately, however, it does not define precisely what this means. 
It leaves it to the fiscal intermediaries to interpret just how many 
absences qualify as ``frequent'' and just how short those absences must 
be. Interpretations of this definition have therefore varied widely.
  As a consequence, there have been far too many instances where an 
overzealous or arbitrary interpretation of the definition has turned 
elderly or disabled Medicare beneficiaries, who are dependent upon 
Medicare home health services and medical equipment for survival, into 
virtual prisoners in their own home. We have heard disturbing accounts 
of individuals on Medicare who have had their home health benefits 
terminated for leaving their homes to visit a hospitalized spouse or to 
attend a family gathering, including, in one case, to attend the 
funeral of their own child.
  Under current law, a Medicare patient must be considered 
``homebound'' if he or she is to be eligible for home health services. 
While an individual is not actually required to be bedridden to quality 
for benefits, his or her condition must be such that ``there exists a 
normal inability to leave home.''
  The statute does allow for absences from the home that are 
``infrequent and of short duration.'' It also gives specific permission 
for the individual to leave home to attend medical appointments, adult 
day care or religious services. Otherwise, it leaves it to the fiscal 
intermediaries to interpret just how many absences qualify as 
``frequent'' and just how short those absences must be. Interpretations 
of this definition have therefore varied widely.
  As a consequence, there have been far too many instances where an 
overzealous or arbitrary interpretation of the definition has turned 
elderly or disabled Medicare recipients, who are dependent upon 
Medicare home health services and medical equipment for survival, into 
virtual prisoners in their own homes.
  The current homebound requirement is particularly hard on younger, 
disabled Medicare patients. For example, I recently met with David 
Jayne, a 40-year old man with Lou Gehrig's disease, who is confined to 
a wheelchair and cannot swallow, speak or even breathe on his own. Mr. 
Jayne needs several skilled nursing visits per week to enable him to 
remain independent and out of an inpatient facility. Despite his 
disability, Mr. Jayne meets frequently with youth and church groups. 
Speaking through a computerized voice synthesizer, he gives 
inspirational talks about how the human spirit can endure and even 
overcome great hardship.

  The Atlanta Journal Constitution ran a feature article on Mr. Jayne 
and his activities, including a report about how he had, with the help 
of family and friends, attended a football game to root for the 
University of Georgia Bulldogs. A few days later, at the direction of 
the fiscal intermediary, his home health agency, which had been sending 
a health care worker to his home for two hours, four mornings a week, 
notified him that he could no longer be considered homebound, and that 
his benefits were being cut off. While his benefits were subsequently 
reinstated due to the media attention given the case, this experience 
motivated him to launch a crusade to modernize the homebound definition 
and led him to found the National Coalition to Amend the Medicare 
Homebound Restriction.
  The current homebound requirement is particularly hard on younger, 
disabled individuals who are on Medicare. The fact is that the current 
requirement reflects an outmoded view of life for persons who live with 
serious disabilities. The homebound criteria may have made sense thirty 
years ago, when an elderly or disabled person might expect to live in 
the confines of their home, perhaps cared for by an extended family. 
The current definition, however, fails to reflect the technological and 
medical advances that have been made in supporting individuals with 
significant disabilities and mobility challenges. It also fails to 
reflect advances in treatment for seriously ill individuals, like Mr. 
Jayne, which allow them brief periods of relative wellness.
  It also fails to recognize that an individual's mental acuity an 
physical stamina can only be maintained by use, and that the use of the 
body and mind is encouraged by social interactions outside the four 
walls of a home.

[[Page S7914]]

  The David Jayne Medicare Homebound Modernization Act of 2002 will 
amend the homebound definition to base eligibility for the home health 
benefit on the patient's functional limitations and clinical condition, 
rather than on an arbitrary limitation on absences from the home. It 
will provide a specific, limited exception to the homebound rule for 
individuals who:
  One, have been certified by a physician has having a permanent and 
severe condition that will not improve;
  Two, who need assistance from another person with 3 or more of the 5 
activities of daily living and require technological and/or personal 
assistance with the act of leaving home;
  Three, who have received Medicare home health services during the 
previous 12 month period; and
  Four, who are only able to leave home because the services provided 
through the home health benefit makes it possible for them to do so.
  We believe that our legislation is budget neutral because it is 
specifically limited to individuals who are already eligible for 
Medicare and whose conditions require the assistance of a skilled 
nurse, therapist or home health aide to make it functionally possible 
for them to leave the home. Our legislation does not expand Medicare 
eligibility--it simply gives people who are already eligible for the 
benefit their freedom.
  This issue was first brought to my attention by former Senator Robert 
Dole, who has long been a vigorous advocate for people with 
disabilities. Our proposal is also supported by the Consortium of 
Citizens with Disabilities, the Visiting Nurse Associations of America, 
the National Association for Home Care, Advancing Independence: 
Modernizing Medicare and Medicaid, AIMM, and the National Coalition to 
Amend the Medicare Homebound Restriction.
  Moreover, the David Jayne Medicare Homebound Modernization Act of 
2002 is consistent with President Bush's ``New Freedom Initiative'' 
which has, as its goal, the removal of barriers that impede 
opportunities for those with disabilities to integrate more fully into 
the community. By allowing reasonable absences from the home, our 
amendment will bring the Medicare home health benefit into the 21st 
Century, and I look forward to working with my colleagues to getting it 
done.
                                 ______