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Patients will be considered confined to the home or homebound if the following two criteria are met:

Criteria 1Only one element is required
Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person to leave their place of residence.
Have a condition such that leaving his or her home is medically contraindicated.

Criteria 2Both must be met
There must exist a normal inability to leave home.
Leaving home must require a considerable and taxing effort.

The patient may still be considered homebound if absences from the home are:
– For religious services
– For healthcare treatment
– For periods of relatively short duration
– To attend adult day care programs
– For infrequent events such as a trip to the barber or a funeral

Examples of homebound status:

– Patient is confined to the home due to a surgical wound on the right foot which causes them to be non-weight bearing on the right foot, limited mobility, ambulation, and at risk of falls. The patient requires help of family to leave the home. Leaving the home is medically contraindicated as it increases risk of infection and may delay healing.
– Patient is confined to the home due to the use of narcotic pain medications associated with their diagnosis. The side-effects of usage causes dizziness, and disorientation which increases their risk of falls and makes it contraindicated for them to leave the home. Patient requires a rollator and leaving the home requires a taxing effort.
– Patient is confined to the home due to extreme weakness, poor balance, and shortness of breath. Patient has had multiple falls in the last 3 months and cannot ambulate for than 15 feet without shortness of breath. The patient uses a cane to walk and leaving the home is difficult for them.
– Patient is homebound due to COPD causing them to have poor balance and extreme shortness of breath and coughing when attempting to walk more than a few feet. Leaving the home is medically contraindicated and puts the patient at risk for falls.


The Patient Driven Grouping Model


Medical Necessity