CMS Issues New Homebound MUSTs

Defining homebound status is something CMS has left as vague for many years. Recently the Office of the Inspector General (OIG) requested that CMS be more specific about what is required for a patient to be considered “homebound.”

CMS has finally responded using the term "confined to the home":

In order for a patient to be considered confined to the home, BOTH of the following criteria must be met:

1. The individual has a condition due to an illness or injury that restricts his or her ability to leave their place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person; or if leaving home is medically contraindicated.

2. The condition of the patient should be such that there exists a normal inability to leave home and, consequently, leaving the home would require a considerable and taxing effort.

This ruling becomes effective November 19,2013.




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