What is Considered a Patient’s Place of Residence?

A patient’s residence is wherever he or she makes his or her home.  This may be their own home, an apartment, a relative’s home, a facility for the aging, or some other type of institution.  An institution can’t be considered a patient’s residence if the institution meets the requirements of §§1861(e)(1) or 1819(a)(1) of the Act.  This includes hospitals, skilled nursing facilities, as well as moth nursing facilities under Medicaid. (Please see the Medicare State Operations Manual, section 2166.)

If a patient is in an institution or distinct part of an institution identified above, the patient is not entitled to have payment for home health services under either Part A or Part B, since such an institution may not be considered their residence.  When a patent remains in a participating SNF following their discharge from active care, the facility may not be considered their residence for home health coverage.

A patient may have more than one home and the Medicare rules do not prohibit a patient from having more than one place of residence.  When a patient, under a Medicare home health plan of care, resides in more than one place during an episode of care, Medicare will not disqualify the patent’s homebound status for purposes of eligibility.  For example, a person may reside in a principal home and also a second vacation home, mobile home, or the home of a caretaker or relative.  The fact that the patient resides in more than one home and, as a result, must transit from one to the other, is not in itself, an indication that the patient is not homebound.  The requirements of homebound must be met at each location.  Please refer to previous Medicare Benefits Post regarding what is considered homebound status.

This information has been obtained from the Medicare Benefits Policy Manual that was implemented and effective on 1/7/14.

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