Despite his disabilities, 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. But when the Atlanta Journal-Constitution ran a feature article on Mr. Jayne and his activities, including a report about how, with the help of family and friends, he had attended a football game to root for the University of Georgia Bulldogs, Mr. Jayne was hit hard by a terrible inequity in our health care system. A few days after the story ran, his home health agency – at the direction of the Medicare fiscal intermediary – notified him that he could no longer be considered homebound, and that his benefits were being cut off, simply because he had been able to muster the strength and spirit for a brief escape from the house in which he is normally confined.
Due to the media attention his case soon drew, Mr. Jayne's benefits were subsequently reinstated, and he went on to found a national effort aimed at modernizing Medicare's home health care rules. Through former Senator Bob Dole, I came to know Mr. Jayne's story, and, in response, I introduced the David Jayne Medicare Homebound Modernization Act, which amends the Medicare homebound restriction to accommodate cases like Mr. Jayne's.
The current requirement that Medicare beneficiaries be "homebound" to be eligible for home health benefit reflects an outmoded view of life for persons who are elderly or live with disabilities. Today, individuals with significant disabilities and mobility challenges have access to technological and medical advances that were once only medical dreams, and the current requirement does not take these developments into account. It also overlooks advances in treatment for seriously ill individuals – like Mr. Jayne – that allow them brief periods of relative wellness. Moreover, it fails to recognize that mental sharpness and physical stamina can only be maintained by use, and that social interactions outside the four walls of a home are important to keeping an individual's faculties keen.
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 the benefit, his or her condition must be such that "there exists a normal inability to leave home." Moreover, leaving home must require "a considerable and taxing effort by the individual." 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. 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.
Another example is an 84-year old woman who lives alone in rural Maine. She is extremely frail and has a history of congestive heart failure, unstable hypertension, back pain caused by osteoporosis, and rheumatoid arthritis. It requires a taxing effort for her to leave her home, and she is only able to do so with some assistance. She would like to go to the nursing home to visit her brother and a close friend, who both reside there, but is only able to do so on extremely rare occasions out of fear that she will lose the home health services that enable her to control her medical conditions and remain in her own home. I have heard other 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.
My legislation will create an exception to the homebound restriction based on the severity of the patient's functional limitations and clinical condition. The home health care benefit needs to be brought into the 21st century. Patients are spending less time in the hospital. More and more procedures are being done on an outpatient basis, and recovery and care for patients with chronic diseases and conditions has increasingly been taking place in the home, making home health care an increasingly important part of our health care system. Millions of our most vulnerable older and disabled individuals are today able to avoid hospitals and nursing homes and stay just where they belong – in the comfort and security of their own homes. It is time to bring the Medicare home health benefit up-to-date, and by allowing reasonable absences from the home, my legislation will take a big step toward bringing it into the 21st Century.