The Department of Health and Human Services (DHHS) has published a final rule to implement Medicare’s Face-to-Face (FTF) provisions for home health and DME under the Medicaid program.
The final rule was posted to the Federal Register on January 28, 2016, with an effective date of July 1, 2016. Medicaid programs are run by state agencies that must coordinate with state legislative bodies. Therefore, the DHHS will allow state agencies to publish compliant initiatives on this rule by July 1, 2017 or July 1, 2018 (depending on the timing of their legislative sessions).
Face-to-Face for Home Health Services
The DHHS has mandated that Medicaid programs implement the requirement for the physician to document a face-to-face encounter with the beneficiary for the primary reason that the beneficiary requires home health services no more than 90 days before or 30 days after the start of home health services.
Face-to-Face for Medical Equipment
Furthermore, the DHHS will update the definition of medical supplies, equipment and appliances to align with the Medicare definition of durable medical equipment (under 42 CFR 414.202). The DHHS is also implementing the requirement for a face-to-face visit related to the beneficiary's primary need for medical equipment within 6 months prior to the start of durable medical equipment (DMR) services. This provision is also adapted from the Medicare Face-to-Face (FTF) Rule for DME. In an effort to reduce the administrative burden placed on providers, and to promote consistency between the two programs, the agency stipulates Medicaid will limit enforcement of the FTF to only those codes subject to the Medicare FTF rule.
The final rule was posted to the Federal Register on January 28, 2016, with an effective date of July 1, 2016. Medicaid programs are run by state agencies that must coordinate with state legislative bodies. Therefore, the DHHS will allow state agencies to publish compliant initiatives on this rule by July 1, 2017 or July 1, 2018 (depending on the timing of their legislative sessions).
Face-to-Face for Home Health Services
The DHHS has mandated that Medicaid programs implement the requirement for the physician to document a face-to-face encounter with the beneficiary for the primary reason that the beneficiary requires home health services no more than 90 days before or 30 days after the start of home health services.
Face-to-Face for Medical Equipment
Furthermore, the DHHS will update the definition of medical supplies, equipment and appliances to align with the Medicare definition of durable medical equipment (under 42 CFR 414.202). The DHHS is also implementing the requirement for a face-to-face visit related to the beneficiary's primary need for medical equipment within 6 months prior to the start of durable medical equipment (DMR) services. This provision is also adapted from the Medicare Face-to-Face (FTF) Rule for DME. In an effort to reduce the administrative burden placed on providers, and to promote consistency between the two programs, the agency stipulates Medicaid will limit enforcement of the FTF to only those codes subject to the Medicare FTF rule.
Telehealth
For both FTF provisions, the DHHS has allowed for the use of Telehealth as a means to complete the face-to-face examination. It will be left up to the individual state agencies to define what types of telehealth will be covered and for which patients it can be covered. But this is an interesting provision that suppliers and providers alike seem to be in favor of (based on the comments in the rule).
What’s Missing
The ruling did not provide a carve-out for how Medicaid will apply the written order prior to delivery provisions that are outlined in the Medicare rule. Under Medicare, every item subject to the FTF must have a valid detailed written order in hand prior to delivery of the durable medical equipment to be compliant. The Medicaid rule also did not address whether or not suppliers will be required to have the face-to-face documentation from the visit in hand prior to delivery. We speculate, that because Medicaid is state run, the individual agencies will issue provisions directly.
Overall, the DHHS and CMS continue to seek opportunities to align Medicare and Medicaid policies and procedures. Stay tuned to the MiraVista blog for additional details on this provision.
For both FTF provisions, the DHHS has allowed for the use of Telehealth as a means to complete the face-to-face examination. It will be left up to the individual state agencies to define what types of telehealth will be covered and for which patients it can be covered. But this is an interesting provision that suppliers and providers alike seem to be in favor of (based on the comments in the rule).
What’s Missing
The ruling did not provide a carve-out for how Medicaid will apply the written order prior to delivery provisions that are outlined in the Medicare rule. Under Medicare, every item subject to the FTF must have a valid detailed written order in hand prior to delivery of the durable medical equipment to be compliant. The Medicaid rule also did not address whether or not suppliers will be required to have the face-to-face documentation from the visit in hand prior to delivery. We speculate, that because Medicaid is state run, the individual agencies will issue provisions directly.
Overall, the DHHS and CMS continue to seek opportunities to align Medicare and Medicaid policies and procedures. Stay tuned to the MiraVista blog for additional details on this provision.
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