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“Confined to the Home” Definition Change

“Confined to the Home” Definition Change November 19, 2013

Effective November 19, 2013, the definition of “Confined to the Home” will be updated.  This change is designed to remove vague terms and make revisions to more accurately reflect the definition noted in the Social Security Act.  This update will provide more definitive guidance to agencies so there will be less confusion, clearer statute enforcement and the increased ability to foster compliance.

In summary, a patient is considered “confined to the home” (homebound) if the following two criteria are met:

Criteria 1 – The patient must either (a) because of illness or injury, need the aid of supportive devices, the use of special transportation, or the assistance of another person to leave their residence; or (b) have a condition where leaving the home is medically unadvised.  If the patient meets one of these criteria, they must also meet both items in Criteria 2.

Criteria 2 –

  • The patient must have a normal inability to leave home, and
  • Leaving home must require considerable effort.

For more complete information, please follow this link to Medicare Learning Network (MLN) Matters No. 8444:  http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8444.pdf

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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