CMS Issues Medicaid Face to Face Rule
March 3, 2016 09:33 AM
The Centers for Medicare & Medicaid Services (CMS) issued a final rulethat would require a face to face encounter for beneficiaries receiving Medicaid home health services, and provides other clarifications and enhancements to the Medicaid program.
The final rule aligns with Medicare timeframes for the face-to-face encounter for home health services and medical supplies, equipment, and appliances. Specifically, the final rule requires that for the initial ordering of home health services the physician must document that a face-to-face encounter that is related to the primary reason the beneficiary requires home health services occurred no more than 90 days before or 30 days after the start of services. For the initial ordering of medical supplies, equipment, or appliances, the physician or authorized NPP must document that the face-to-face encounter occurred no more than six months prior to the start of services. The face-to-face encounter for home health and medical supplies, equipment, and appliances may be performed by the physician or certain authorized NPPs. The rule also provides for the use of telehealth, as defined by the state, for the F2F encounters.
In addition, the final rule provides a definition of medical supplies, equipment, and appliances and expands coverage of medical supplies, equipment, and appliances under the home health benefit. Certain items that had previously only been offered under sections 1915(c) and 1915(i) waivers will now meet the definition of medical supplies, equipment, and appliances and thus be covered under the state plan home health benefit. The rule clarifies that medical supplies, equipment, and appliances may not be restricted to the home setting.
Further, the rule incorporates into regulation CMS’ longstanding policy that states may not require an individual to be “homebound” in order to receive home health services or restrict services to be furnished in the home itself.
The National Association for Home Care & Hospice received clarification from CMS officials that the Medicaid physician F2F encounter documentation is intended to be less prescriptive than the Medicare home health F2F encounter requirements. CMS is allowing greater flexibility within the individual state regulations as to what will be required for sufficient documentation of the F2F encounter. NAHC, therefore, encourages agencies to work closely with their state Medicaid offices to ensure reasonable application of the final rule regarding the F2F encounter requirements.
The effective date for the rule is July 1, 2016. However, CMS recognizes that some states may require legislative action in order to effectively comply with all provisions in the rule. For states that require a legislative session and meet annually, the rule will be effective July 1, 2017. For states where the legislature meets every two years and requires legislative action to comply with the rule, the effective date will be July 1, 2018.