Some States Improperly Restrict Eligibility for Medicaid Mandatory Home Health Services

Source: U.S. Department of Health and Human Services, Office of Inspector General, OEI-07-13-00060, July 1, 2013

From the summary:
Federal regulations prohibit the arbitrary denial or reduction of the amount, duration, and scope of a required service on the basis of a beneficiary’s diagnosis, type of illness, or condition. In a 2000 policy letter, CMS notified State Medicaid agencies that restricting eligibility for mandatory home health services to homebound individuals violates these regulations. In July 2011, CMS published a Notice of Proposed Rulemaking that would revise Medicaid regulations to clarify that home health services cannot be restricted to individuals who are homebound or to services furnished in the home; the rule had not yet been finalized at the time of this report. At least one State was known to have improper homebound restrictions on its mandatory home health benefit from 2005 to 2010. We determined how many States nationwide had such improper restrictions in their policy documents in January 2013…. Eleven States have language-one in its State plan and 10 in other State policy documents-that restricts eligibility for the mandatory home health benefit to homebound individuals in violation of CMS’s interpretation of the applicable statute and regulation. These 11 States are: Alabama, Arkansas, Indiana, Montana, Nebraska, New Mexico, North Dakota, Pennsylvania, South Dakota, Utah, and West Virginia. Two of the eleven States, New Mexico and Utah, stated in their responses to our request that although their policies restricted eligibility for home health services to homebound individuals, those policies were incorrect and the restrictions were not being enforced. …