CMS Releases Medicaid Home Health Services Final Rule

Required Face-to-Face Encounter Timeline Aligns With Similar Medicare Regulations

February 09, 2016 01:52 pm News Staff

Family physicians know that sometimes patients can be best cared for in their homes. That truth was reinforced last fall when the AAFP's 2015 Congress of Delegates reaffirmed the Academy's policy on home health care.

That policy defines the term as "direct patient care, plus the management and coordination of patient care services" provided in a residential setting. The policy further states that not only have family physicians always provided home health care, they are "particularly well-qualified and trained" to provide such care and should be appropriately paid for providing and managing these services.

With that background in mind, CMS' recent announcement of a final rule( that adds new requirements for Medicaid home health services is important news for a large swath of family physicians. The rule was published in the Feb. 2 Federal Register.

From a physician's standpoint, perhaps the most important aspect of the rule -- as outlined in the summary of major provisions -- is the requirement that physicians document face-to-face encounters with Medicaid patients within certain time frames when initially ordering home health services and certain related medical supplies and equipment.

The home health services covered by the rule are described in a related CMS fact sheet( as nursing services and home health aide services.

Specifically, the final rule requires that physicians document that a face-to-face encounter related to the primary reason the beneficiary would require home health services occurred no more than 90 days before or 30 days after the start of services.

Also, when initially ordering medical supplies, equipment or appliances, a physician -- or an authorized nonphysician provider -- must document that a face-to-face encounter occurred no more than six months before the initiation of services.

The new rule aligns closely with similar Medicare regulatory requirements.

Either a physician or an authorized nonphysician practitioner can perform the face-to-face encounter. However, CMS noted that the final rule "maintains the role of the physician in ordering Medicaid home health services and medical supplies, equipment and appliances."

The rule also clarified that the face-to-face process includes telehealth services.

According to CMS, July 1, 2016, marks the rule's effective date. However, based on public comments received on the proposal, CMS understood that some states and health care professionals would need additional time to implement the rule appropriately.

Therefore, the agency allowed some leeway in the compliance date that ranges from July 1, 2017, for states where the legislature will convene in that year, to July 1, 2018, for states with two-year legislative sessions.

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