Thursday, October 24, 2013

CMS Clarifies “Confined to the Home” Definition

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

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