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Update on the "Confined to Home" Definition

The Centers for Medicare and Medicaid Services (CMS) revised the Medicare Benefit Policy Manual to clarify the definition of "confined to the home" for purposes of the Medicare home health benefit. The revised definition is explained at length in a Medicare Learning Network article, MLN Matters® Number: MM8818.

This follows an earlier version of MLN Matters with instructions on the homebound definition along with specific requirements of the definition. The most recent changes in the definition are intended to:

  • present the requirements first:
  • more closely align the Medicare Benefit Policy manual with the Social Security Act;
  • help prevent confusion;
  • promote a clearer enforcement of the statute;  and
  • provide more definitive guidance to Home Health Agencies (HHAs) in order to foster compliance.

The official instruction, CR 8818 issued to Medicare Administrative Contractors (MACs) regarding this change are available here.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871