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CMS Finalizes Face-to-Face Encounter Requirements Prior to Initiation of Medicaid Home Health Services

on Friday, 11 March 2016 in Health Law Alert: Erin E. Busch, Editor

Nearly five years after publishing the proposed rule, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final rule requiring documentation of face-to-face encounters to certify home health services for Medicaid beneficiaries. The final rule, published in the February 2, 2016 Federal Register, finalized the proposed rule originally published in July 2011 which implemented section 6407 of the Patient Protection and Affordable Care Act (ACA).

Section 6407 of the ACA required that either a physician or nonphysician practitioner document a face-to-face encounter with a home health service beneficiary “within a reasonable timeframe.” Under the new regulation “reasonable timeframe” is defined as either 90 days prior to or 30 days after the initiation of home health services. CMS indicated that it anticipates a majority of the certifications to occur in the 90 day period prior to the start of services. This timeframe aligns with Medicare requirements.

Within the approximately four month window, either a physician or nonphysician practitioner (NPP) can perform the encounter. Those NPPs permitted to perform the encounters are either a nurse practitioner or clinical nurse specialist working collaboratively with a physician as required by state law, a certified nurse midwife, or a physician assistant working under the supervision of a physician.

And CMS did not limit the face-to-face encounter to physical meetings between health care providers and the beneficiaries. An encounter can be fulfilled through telehealth or telemedicine modalities as long as the delivery model was “recognized by the state as a physician or [nonphysician practitioner] encounter under its state approved plan.”

It should also be noted that the initial encounter, whether through telehealth/medicine or an in-person visit, must also be related to the underlying reason why the beneficiary requires home health services.

The final rule’s effective date is July 1, 2016; although CMS—acknowledging operational and budgetary difficulties at the state level—delayed compliance for either one or two years. If the state’s legislature met during that year, then compliance is delayed one year. If the state’s legislature has yet to meet during that year, compliance is delayed two years.

Clink the following links to access the proposed and final rules, titled “Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health.”


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