Skip to Main Content

Print | Bookmark | Font Size: + |

April 21, 2026

CR14355: IOM Updates Related to Individuals in a Penal Authority’s Custody

Change Request (CR) 14355 updates the internet-only manual (IOM) to correspond with regulations at 42 CFR 411.4(b):

For Medicare payment purposes, an individual is in a penal authority’s custody if the individual is:

  • Incarcerated in a jail, prison, penitentiary, or similar institution.
  • Temporarily outside of a jail, prison, penitentiary, or similar institution on medical furlough or similar arrangement.
  • Escaped from confinement by a penal authority.
  • Required to reside in a mental health facility under a penal statute or rule.

Individuals NOT in a penal authority’s custody may include but aren’t limited to individuals who are:

  • Released to the community pending trial (including those in pretrial community supervision and those released pursuant to cash bail).
  • On parole.
  • On probation.
  • On home detention or home confinement.
  • Required to live in a halfway house or other community-based transitional facility.

For complete details, please review:

spacer

26 Century Blvd, Suite NT600, Nashville, TN 37214 © CGS Administrators, LLC. All Rights Reserved