Medicare Home Health: Clarifying the Homebound Definition Is Likely to Have Little Effect on Costs and Access (GAO-02-555R)

Medicare's home health benefit provides skilled nursing and other services to beneficiaries who are homebound. The Department of Health and Human Services (HHS) had a long-standing policy that beneficiaries who regularly attend adult day care were not considered homebound, particularly if the purpose of attending was to receive nonmedical or custodial care. In 2000, Congress indicated that Medicare beneficiaries who attended adult day care could still be considered homebound if they still met the other homebound requirements. GAO found that clarifying the Medicare definition of homebound to allow home health beneficiaries to participate in adult day care will have little effect on program costs or access to services because the number of affected individuals is small. On the basis of National Long Term Care Survey data, GAO estimates that 0.2 percent of elderly Medicare beneficiaries who attended adult day care had mobility or cognitive impairments that might make some eligible for Medicare home health services.