Collins plans amendment to Medicare home care rules

WASHINGTON – The homebound restriction that requires elderly or disabled patients with terminal or degenerative diseases to remain in their homes in order to qualify for home health services under Medicare is no longer relevant to today’s world, according to Sen. Susan Collins.

On Thursday, the Maine Republican joined a press conference with other lawmakers and critics of the federal rule who are anxious to redefine the rule so patients have more freedom of movement.

“The current requirement reflects an outmoded view of life for people who live with serious disabilities,” Collins said, adding it “fails to reflect the technological and medical advances that have been made supporting individuals with significant disabilities and mobility challenges.”

Next week, Collins intends to offer an amendment to change that rule as part of a larger debate on health care so patients can leave the home more often.

Collins said the amendment would give patients the freedom to go to a family event or participate in their communities without jeopardizing their home health services benefits.

The current rule requires that a patient be “homebound” in order to receive home health care. Patients are not required to be bedridden, but the instances when an elderly or disabled person can leave his home, as well as the duration of these occasions, are limited.

Collins’ homebound exception would be limited to people whose conditions necessitate the assistance of a health aide, skilled nurse, or therapist; these are the patients who already receive these benefits or are eligible for home health care.

Georgia resident David Jayne said the homebound restriction limits the occasions a person can leave his home and regulates the duration of these absences. Such requirements are the equivalent of “house arrest,” he said.

“I hardly think that the homebound restriction was intended to be this cruel and vicious,” said Jayne, who is suffering from ALS, often referred to as Lou Gehrig’s disease. “But it is stealing away from me the opportunity to take part in my children’s precious childhood.”

Collins has named her proposed amendment in honor of Jayne.

“The David Jayne amendment 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,” she said. “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 in getting it done.”

Former Republican Sen. Bob Dole of Kansas and members of the Visiting Nurses Association of America also attended the press conference to address the homebound Medicare restriction for home health care.

Collins and Dole both said current laws are outdated and do not address developments in technology that have altered the needs and abilities of patients with degenerative or terminal illnesses.

Dole said there is bipartisan support for this issue and doubts there will be opposition when the amendment comes to a vote.

“The key to this legislation is having people hear it and understand it,” Dole said.

Dole is volunteer honorary chairman of the National Coalition to Amend the Homebound Restriction.

Rep. Edward Markey, D-Mass., who also took part in the news conference, said that despite estimates by the Congressional Budget Office that the amendment would cost more than $1 billion, supporters are certain the amendment will create no new costs.

“We completely and totally disagree with the budget office,” Markey said. “We do not believe it will cost a single nickel,” he said.