On January 27, 2016, the Centers for Medicare and Medicaid Services (CMS) issued a final rule requiring documentation of face-to-face encounters for physicians ordering home health services and certain medical equipment for Medicaid beneficiaries as required by the Patient Protection and Affordable Care Act of 2010. While the final rule becomes effective on July 1, 2016, CMS is delaying compliance until July 1, 2017 for states whose legislatures meet in 2016 or until July 1, 2018 for all other states.
The rule will require a physician to document a face-to-face encounter with the beneficiary related to the primary reason the beneficiary requires home health services within 90 days before or within 30 days after the start of the services. The rule requires physicians initiating the use of medical equipment for a Medicaid beneficiary to document a face-to-face encounter with the beneficiary related to the primary reason the beneficiary requires medical equipment by no more than 6 months prior to the start of services. Most notably, the face-to-face encounter is not limited to physicians and may also be performed by a nurse practitioner, clinical nurse specialist, certified nurse midwife, or physician assistant in accordance with state law. An attending acute or post-acute physician may also perform the face-to-face encounter when a Medicaid beneficiary is admitted to home health immediately after an acute or post-acute stay. Such face-to-face encounters can be made through the use of telehealth as permitted by state law.
In addition to requiring face-to-face encounters, the final rule states that Medicaid home health services cannot be limited to beneficiaries who are homebound and can be received in any setting in which normal life activities take place with the exception of a hospital, nursing facility, intermediate care facility for intellectually disabled individuals or any other setting where payment could be made for inpatient services including room and board. A similar distinction is made for the coverage of medical supplies, equipment, and appliances, which is expanded to include items suitable for use in any setting in which normal life activities take place. CMS states that the inclusion of medical supplies, equipment and appliances for use in a non-institutional setting allows states to continue to establish medical necessity criteria to authorize such items but does not allow states to deny requests on the basis that they are used outside of the home.
The final rule will be published in the Federal Register on February 2, 2016.
*Wendy Wright is admitted only in North Carolina. Her practice is supervised by principals of the firm admitted in the District of Columbia.