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CMS Releases Final Face-to-Face Rule for Medicaid
On January 27, 2016, CMS published the final rule to Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health. 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. The final rule also requires that for the initial ordering of certain medical equipment, the physician or authorized non-physician practitioner (hereinafter noted as NPP — i.e. physician assistant, nurse practitioner, or clinical nurse specialist) must document that a face-to-face encounter that is related to the primary reason the beneficiary requires medical equipment occurred no more than 6 months prior to the start of services. However, the final rule maintains the role of the physician in ordering Medicaid home health services and medical equipment. NPPs do not have the authority in signing off on the orders.
In addition, CMS finalized that the face-to-face encounter can be performed through the use of telehealth. The face-to-face encounter can be met though a telehealth delivery model that is recognized by the state as a physician or NPP encounter under its approved state plan.
Due to the potential operational and budgetary implications of this rule, CMS is delaying compliance with this rule for up to one year if a state legislature has met in that year, otherwise two years. CMS has also delayed the effective date of this rule to July 1, 2016.
Here is is our summary of the rule. AAHomecare is still analyzing this final rule and will notify membership with more information.