On October 18, 2013 CMS issued
Change Request # CR 8444 to clarify the definition of “Confined to the
Home”. CR8444 clarifies the
definition of the patient being "confined to the home" to more
accurately reflect the definition as articulated at Section 1835(a) of the
Social Security Act (the Act). In addition, the Centers for Medicare &
Medicaid Services (CMS) removed vague terms, such as "generally
speaking", to ensure the definition is clear and specific.
In
the Calendar Year (CY) 2012 Home Health (HH) Prospective Payment System (PPS)
proposed rule published on July 12, 2011, CMS proposed their intent to provide
clarification to the Benefit Policy Manual language regarding the definition of
"confined to the home". In the CY 2012 HH PPS final rule published on
November 4, 2011 (FR 76 68599-68600), CMS finalized that proposal. In order to
clarify the definition, CMS is amending its policy manual as follows:
For
purposes of the statute, an individual shall be considered “confined to the
home” (homebound) if the following two criteria are met:
Criteria-One:
The
patient must either: Because of illness or injury, need the aid of supportive
devices such as crutches, canes, wheelchairs, and of residence: OR Have a condition such that leaving his or
her home is medically contraindicated. If the patient meets one of the
Criteria-One conditions, then the patient must ALSO meet two additional requirements
defined in Criteria-Two below.
Criteria-Two:
There
must exist a normal inability to leave home: AND Leaving home must require a
considerable and taxing effort.
This
policy becomes effective on November 19, 2013.
For more information please view the CMS MLN Matters Link and Medicare
Benefit Policy Link below:
CMS MLN Matters Link
Pub
100-02 Medicare Benefit Policy Transmittal 172 Link
No comments:
Post a Comment