New Medicaid Rules

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New Medicaid Rule Requires face-to-face Doctors’s Visit before Home Healthcare Services

Beginning July 1st 2016, physicians must document a face-to-face encounter with a patient to validate Medicaid coverage for home health services and medical equipment. A similar rule has long been in effect for Medicare. The final regulations released Wednesday imposing a similar rule for Medicaid come nearly five years after the CMS first proposed the policy under a provision of the Affordable Care Act. To validate the need for coverage under the new rule, a physician must document that a face-to-face patient encounter took place no more than 90 days before, or 30 days after, the start of home health services. For a patient to get medical equipment, a physician or authorized provider must document that an encounter took place no more than six months before the equipment was received.

The rule does not apply to Medicaid managed care. The Center for Medicaid and Medicare Services said it is deferring to states to determine the application of the face-to-face requirement in managed-care plans to best meet the needs of their beneficiaries. The CMS did not provide an estimate of the savings it expects to achieve with the rule. The agency previously estimated that a similar Medicare policy would save the program $2.29 billion between 2010 and 2019.

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