Home Health & Hospice

Defining "Confined to Home"

Homecare Insider, November 11, 2013

On October 18, the Centers for Medicare & Medicaid Services (CMS) issued CR 8444. This CR clarifies the definition of the patient as being "confined to the home" to more accurately reflect the definition as articulated at Section 1835(a) of the Social Security Act. In addition, vague terms, such as "generally speaking," have been removed to ensure clear and specific requirements of the definition.

According to the CR, these changes present the requirements first and more closely align the policy manual with the Act. This will prevent confusion, promote a clearer enforcement of the statute, and provide more definitive guidance to home health agencies in order to foster compliance.

On October 18, CMS released the MLNMatters article, “Home Health - Clarification to Benefit Policy Manual Language on ‘Confined to the Home’ Definition” which provides further details on these changes.

The article states that, 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 walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence, OR
  • Have a condition such that leaving his or her home is medically contraindicated

Criteria Two
If the patient meets one of the Criteria One conditions, then the patient must ALSO meet two additional requirements defined in Criteria Two:

  • There must exist a normal inability to leave home
  • Leaving home must require a considerable and taxing effort

To read CR 8444, click here.

To read the MLNMatters article, click here.