In re Paula P

(SSA Office of Hearings & App. Nov. 2, 1996). ; Clearinghouse Number: 51576

Description

Claimant, Although Attending Adult Day Health Program Outside, Is "Homebound" for Medicare Purposes

Abstract

The administrative law judge (ALJ) has held that claimant, although attending a health program outside her home, is entitled to Medicare coverage for home health services. Claimant, who has multiple sclerosis, received Medicare-covered home health services to assist her in her daily activities. At her own expense, she also participated in an adult day health program three days a week at a rehabilitation center, where she received physical and occupational therapy as well as personal care assistance and therapeutic recreation. For that reason the fiscal intermediary terminated her Medicare coverage for home health services; she was not "homebound" by definition. Claimant appealed. The ALJ deemed claimant to be confined to her home because she required personal and supportive device (wheelchair) assistance in leaving that home and attributed her attendance at the health program to her need to receive medical treatment. Thus within the meaning of the Social Security Act claimant was confined to her home and entitled to Medicare coverage for home health services.

Additional Information

Attorney Information
Appellant represented by Evelyn E. Rinzler (paralegal), Contra Costa Legal Services Foundation, 1017 MacDonald Ave., P.O. Box 2289, Richmond, CA; (510) 233-9954.
Docket Date
1996-11-02 00:00:00+00:00