Proposed Rule Issued on Home Health Face-to-Face Requirement

On July 5, 2011, CMS issued a proposed rule that would require a physician who is ordering home health services under Medicaid to document that a face-to-face exam with the patient has occurred. The proposal, called for by the Patient Protection and Affordable Care Act (ACA), requires a face-to-face exam with a physician for home health and durable medical equipment (DME) under both Medicare and Medicaid.

Beginning on April 1, 2011, CMS has required a face-to-face exam prior to certification for Medicare home health for patients, and it has been subject to push back from Congress and the homecare and physician communities. Yesterday’s proposed rule expands this requirement to patients who require home health services under Medicaid as well as clarifies the definition of “medical supplies, equipment and appliances,” which is the term used for DME under the Medicaid home health services benefit.

CMS has not yet issued a rule to apply the face-to-face exam requirement to DME patients under the Medicare program. However, the proposed rule indicates the items that will be subject to the DME face-to-face exam requirement for Medicare will also require a face-to-face exam prior to ordering the items under Medicaid.

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