US · guidance
CMS Pub. 100-02, ch. 8, § 30.7.2
Whether Available Alternatives Are More Economical in the
Individual Case
(Rev. 261, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19)
A3-3132.6.B, SNF-214.6.B
If the A/B MAC (A) determines that an alternative setting is available to provide the
needed care, it considers whether the use of the alternative setting would actually be more
economical in the individual case.
EXAMPLE 1:
If a patient's condition requires daily transportation to the alternative source of care (e.g.,
a hospital outpatient department) by ambulance, it might be more economical from a
health care delivery viewpoint to provide the needed care in the SNF setting.
EXAMPLE 2:
If needed care could be provided in the home, but the patient’s residence is so isolated
that daily visits would entail inordinate travel costs, care in a SNF might be a more
economical alternative.
History
(Rev. 261, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
416fa880dd9a67703f2739d0b94c53bd38e44b97593bf5f506b971917e951cfa
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