CMS Issues Final Rule on Medicaid Face-to-Face Requirements for Home Health Services.

Date posted: March 1, 2016

The Centers for Medicare & Medicaid Services (CMS) recently released a final rule requiring documentation related to Medicaid coverage of medical equipment in home health services.  The rule requires physicians placing initial orders for durable medical equipment (DME) for beneficiaries to provide documentation that a face-to-face encounter took place within a specified period.  Further, the final rule aligns Medicare home health service requirements with definitions across related regulations, and expands coverage for DME.

The final rule contains the following provisions:

  • Coverage is not restricted to homebound beneficiaries;
  • Medicaid home health services are not limited to services furnished in the home;
  • To initiate home health services, the face-to-face encounters must occur no more than 90 days before or 30 days after the start of services;
  • To initiate medical equipment, the face-to-face encounter cannot have taken place more than 6 months prior to the start of services;
  • The physician encounter must relate to the beneficiary’s need for the medical equipment, supplies, or appliances;
  • Certain non-physician practitioners are authorized to perform face-to-face encounters; and
  • Physicians may conduct face-to-face encounters using telehealth systems.

Additionally, CMS clarified the definition of medical supplies, equipment, and appliances under the regulation.  Medicare defines DME as items that: (1) serve a medical purpose; (2) are generally not useful to an individual absent illness or injury; (3) can withstand repeated use; and (4) are reusable or removable.  However, previous Medicaid regulations did not specifically define these categories, resulting in inconsistent application.  The final rule aligns the Medicaid definition of DME with the Medicare definition to provide uniformity.

The final rule will take effect on July 1, 2016.

The final rule is available at:

https://www.gpo.gov/fdsys/pkg/FR-2016-02-02/pdf/2016-01585.pdf.

The DME list of specified covered items subject to the requirement i0s available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/DME_List_of_Specified_Covered_Items_updated_March_26_2015.pdf.

 

Medicaid Program; Face-to-Face Requirements for Home Health Services; Policy Changes and Clarifications Related to Home Health; Final Rule, 81 Fed. Reg. 5529, 5529-5567 (February 2, 2016).

 

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