CMS Issues Final Rule for Medicaid Beneficiaries Face-to-Face Encounters

February 2, 2016

Last week, CMS published a final rule clarifying, and adding to, the requirements for face-to-face encounters for Medicaid beneficiaries to be eligible to receive home health services, effective July 1, 2016. The additional requirements include:

  • 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 home health services occurred no more than 90 days before or 30 days after the start of services.
  • The rule allows encounters to be conducted via telehealth, "subject to requirements in section 1834(m)" of the Affordable Care Act. The agency notes that telephone calls or email will not suffice for face-to-face encounters, but puts the onus on states to determine which forms of telehealth can be used.
  • For the initial ordering of certain medical equipment, the physician or authorized non-physician practitioner (NPP) must document that a face-to-face encounter that is related to the reason the beneficiary requires medical equipment occurred no more than 6 months prior to the start of services.
  • The face-to-face encounter for home health and medical equipment may be performed by the physician or certain authorized NPPs.

This rule also aligns the timeframes for the face-to-face encounter with similar regulatory requirements for Medicare home health services and codifies current Medicaid policies for coverage of home health services, including clarifying in the definition of medical supplies, equipment, and appliances to better align with the Medicare program’s definition of durable medical equipment (DME) at §414.202. 

The final rule can be found here: https://www.federalregister.gov/regulations/0938-AQ36/face-to-face-requirements-for-home-health-services-policy-changes-and-clarifications-related-to-home.