6 Key Takeaways from the New Face-to-Face Regulation for Medicaid Home Healthcare Services

On February 2, 2016, the Centers for Medicare and Medicaid Services released a new regulation requiring patients who receive Medicaid benefits for home healthcare services to have a face-to-face visit. This regulation requires physicians to document face-to-face encounters with the Medicaid beneficiary for the authorization of home health services within certain timeframes.

According to CMS, the final rule aligns with Medicare timeframes for the face-to-face encounter for home health services and medical supplies, equipment, and appliances. The final rule requires that for the initial ordering of home health services (nursing services and home health aide 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 final rule maintains the role of the physician in ordering Medicaid home health services and medical supplies, equipment, and appliances.

Take a look at the 6 Key Points Regarding the New Regulation:

1. The face-to-face regulation will go into effect on July 1, 2016
2. The encounter must relate to the patient’s need for home health services, such as nursing and home health aide services
3. The face-to-face encounter must occur no more than 90 days before or 30 days after the start of care date
4. There is no need for the patients to be homebound
5. This final rule provides a definition of medical supplies, equipment, and appliances unlike the previous regulation. Based on this new definition, this rule will expand coverage of medical supplies, equipment, and appliances under the home health benefit
6. Telehealth is an eligible face-to-face encounter

AudioEductator’s expert speaker Robert Markette will be conducting an informative audio session on Face-to-Face audits, PPS Final Rule, and more. This session will give you ample opportunities to learn about the requirement of the revised face to face regulations.

Source: CMS