CMS High-Needs Criteria

CRITERIA TABLES

Eligibility for the Home-Based Complex Primary Care Program is based on CMS's high-needs criteria. Of the seven criteria, patterns one and two come with specific lists.

PATTERN 1

A condition that impairs mobility

Medicare publishes a list of specific diagnoses that can qualify a patient for our program. This pattern includes things like stroke with weakness, paraplegia, MS, cerebral palsy, spinal cord injury, ventilator dependence, end-stage heart failure, stage 3 or 4 pressure ulcers. The full list can be found below:

Pattern 1 List

PATTERN 2

Qualifying home equipment

Medicare publishes a list of specific equipment that can qualify a patient for our program. any of these were prescribed in the past 12 months. includes things like hospital beds, patient lifts, trapeze bars, standing frames, seat lifts, pressure-reducing mattresses. The full list can be found below:

Pattern 2 List