NAHC Meets with CMS to Discuss Face-to-Face Requirement
Meeting an attempt to stave off a NAHC-led lawsuit against CMS on the F2F topic
May 14, 2014 08:26 AM
NAHC President Val J. Halamandaris and Vice President for Law Bill Dombi met on May 8 with the new Deputy Administrator of the Centers for Medicare and Medicaid Services, Sean Cavanaugh, and a number of other CMS officials to determine if the industry’s growing concerns with the Medicare face-to-face rule can be resolved without resorting to a lawsuit in federal court. Earlier this year, the NAHC Board of Directors approved the filing of a nationwide lawsuit challenging CMS’s implementation of the requirement in the Affordable Care Act that Medicare patients have a face-to-face physician encounter in order to qualify for the payment of care.
NAHC has held off on filing the lawsuit to date as CMS indicated that it wanted to talk about a possible resolution of the industry’s complaints. At the meeting, the serious concerns with the documentation requirements were expressed in depth. NAHC is focusing these discussions and the lawsuit on the documentation requirements because it will require Congress and the President to amend the ACA law itself to eliminate the face-to-face requirements overall.
The immediate or near-term goals set for the CMS by NAHC include the elimination of the physician narrative requirement in the face-to-face encounter documentation. Since such a change would require CMS to amend the regulation, the interim goal is to have CMS suspend claim reviews and denials based on the narratives. Other changes such as the development of a model form, clarifications on the identity of the qualifying physician for face-to-face encounter certification, and potential elimination of the requirement for patients transferred from the hospital to home health care remain on NAHC’s broader agenda.
Based on the discussions at the CMS meeting, NAHC is further holding on filing the lawsuit to give CMS the opportunity to fully evaluate the concerns and the changes sought by NAHC. “I believe that CMS recognizes the validity of our concerns and the reasonableness of the corrective action that we requested in order to hold off on litigation at this time,” stated Halamandaris. “However, if it appears that we are not making sufficient and expedited progress with CMS, the lawsuit is fully prepared for immediate filing in federal court in Washington, D.C.,” he added.
NAHC is hoping to take advantage of a window of opportunity to secure formal changes in the face-to-face encounter rule that comes with the publication of a proposed rule on 2015 payment rates that is due in late June or early July. Still, for NAHC to wait for that formal rule, it is crucial that enforcement activity on the documentation requirements be suspended in the interim as a showing of good faith by CMS. In the early implementation of the face-to-face rule, CMS suspended enforcement to provide time for all affected parties to institute compliance measures. A targeted suspension is therefore a well-used approach to addressing problems such as those occurring today.
A series of discussion/negotiation meetings is being prepared for the period between now and the issuance of a final rule. NAHC will evaluate progress at each meeting step to determine if litigation is necessary. “I want to thank the vast number of NAHC members who shared their concerns with the face-to-face documentation requirements and put us in a great position to present the strong evidence that changes are needed,” stated Halamandaris. “That effort has given us what we need to succeed in discussions with CMS or before a federal judge if necessary.”