Congress Issues Report to CMS Asking it to Justify its Face-to-Face Policy
Report accompanied the 2015 omnibus continuing resolution that funds the government through FY 2015
December 19, 2014 10:28 AM
Congress has sent a report to the Centers for Medicare and Medicaid Services (CMS) asking the agency to justify its face-to-face requirement. The House and Senate report, which accompanied the recently passed 2015 omnibus appropriations bill, says that CMS should “quantify and explain how the policy directing physicians to conduct face-to-face certifications for home health care has prevented fraud, increased access to health care, and impacted costs to the Medicare and Medicaid programs” as part of its fiscal 2016 budget request.
Additionally, the report Congress sent to CMS states that CMS should include ways to simplify the provider documentation for face-to-face encounters as part of its fiscal 2016 budget request.
With the new face-to-face documentation requirements scheduled to take effect on January 1, 2015, Congress’ report is the latest in a series of requests that CMS reevaluate its face-to-face requirements. Last week, both NAHC and its affiliate Forum of State Associations sent separate letter to CMS asking for a phase-in approach to enforcement of the face-to-face requirement. To date, CMS has not issued any guidance or initiated any education on the new requirement that physicians have sufficient documentation in their own files to support the certification of homebound status and skilled care need.
As part of its analysis of the ongoing face-to-face issue, Inside Health Policy recently summed up the continuing frustration the home care and hospice community feel surrounding the face-to-face requirement:
“Industry has viewed the Affordable Care Act's face-to-face requirements as flawed and unclear. As part of the face-to-face documentation, a physician narrative was required to describe a patient's clinical conditions and why a beneficiary needs home health care. The National Association for Home Care and Hospice sued CMS over the face-to-face requirements and physician narrative earlier this year because of confusion around what the narrative required. Home health providers said they were seeing claims denied because of documentation problems over which they had no control.
In the home health final pay rule, CMS eliminated the physician narrative requirement from the face-to-face documentation following the lawsuit. The changes are set to go into effect in 2015.
HHS, in a recent report on the agency's finances, also said that the face-to-face denials were driving up Medicare's improper payment rates.
“HHS believes clarifying the face-to-face requirements will lead to a decrease in these errors and improve provider compliance with regulatory requirements, while continuing to strengthen the integrity of the Medicare program,” HHS' financial report says.
Bill Dombi, vice president for law at the National Association for Home Care and Hospice, noted the bi-partisan, bicameral support behind the report's comments on face-to-face issues, and said that support backs up the industry's concerns. Some lawmakers have also recently pushed CMS to consider a settlement for home health denials that have occurred because of face-to-face documentation issues.
In addition to the action taken by Congress, NAHC, the Forum of State Associations and other home care and hospice advocates, NAHC is asking its members to Contact CMS Administrator Tavenner and their lawmakers asking for a phase-in approach the new F2F regulations.
To learn more about this issue and to take action, please see NAHC Report, December 17, 2014.
To read more about the letter sent to CMS by the Forum of State Associations, please see NAHC Report, December 16, 2014.
To read more about the letter sent to CMS by NAHC, please see NAHC Report, December 12, 2014.