Face-To-Face Encounter Requirement for Medicaid Home Health/DME
On July 12, 2011, CMS published a proposed rule that would implement an Affordable Care Act (ACA) requirement that physicians document the existence of a face-to-face encounter (including through the use of telehealth) with a Medicaid eligible individual within certain timeframes as a condition of Medicaid coverage of home health services. Likewise, Medicaid programs would be required to adopt face-to-face encounter requirements for the provision of supplies, equipment and appliances that parallel Medicare requirements pertaining to documentation of face-to-face encounters for DME. That is, CMS would only require that, for items of DME specified by CMS under the Medicare program as subject to a face-to-face encounter requirement, the physician must document that a face-to-face encounter that is related to the primary reason the individual requires the item has occurred no more than 90 days before the order is written or within 30 days after the order is written. CMS intends to issue additional guidance to states on this provision. The proposed rule also would clarify that states may not limit home health services to services delivered in the home; that is, a beneficiary is not prohibited from receiving home health services in any non-institutional setting in which normal life activities take place. Finally, the rule would clarify the definition of medical supplies, equipment, and appliances for Medicaid purposes to better align with the Medicare program’s definition. Comments will be accepted until September 12, 2011.
