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:
- CR14355
(Medicare Benefit Policy) - CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 16, sections 40, 40.7, 50.3.3

- CR14355
(Medicare Claims Processing) - CMS Medicare Claims Processing Manual (Pub.100-04), Chapter 1, section 10.4


