Coming soon to all Medicaid: face-to-face rule

Friday, January 29, 2016

WASHINGTON – CMS has put physicians and HME providers on alert that they must soon comply with a face-to-face rule for Medicaid recipients.

Starting July 1, physicians must document that they’ve conducted face-to-face visits with Medicaid recipients no more than six months prior to those patients receiving certain home medical equipment and services, according to final regulations published last week.

“When the Affordable Care Act was enacted (in 2010), the face-to-face rule applied to Medicaid, as well,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “Even though CMS delayed Medicare enforcement, it did not apply to Medicaid. Many states started the enforcement back then; some have not, whether intentionally or not knowing. Now they will have to ‘know.’”

CMS will delay compliance with the rule for up to two years, according to the regulations, which will be published in the Federal Register on Feb. 2.

Even though the regulations span 147 pages, CMS has left certain details, like a written order prior to delivery requirement that’s part of a similar face-to-face rule for Medicare, up for interpretation, stakeholders say.

“The regulations, for example, don’t call out a written order protocol, though they refer to it in global terms,” said Andrea Stark, a reimbursement consultant with MiraVista. “We should assume conservatively that it applies broadly, here, too.”

While the rule for Medicaid builds on a rule already in effect for Medicare, there are nuances between the two, stakeholders say. One example: The rule for Medicaid OKs telehealth for face-to-face visits.

“(The Medicare rule) doesn’t really talk about that,” Stark said. “They don’t include it or exclude it. But, (in the Medicaid rule), there is language about telehealth.”

CMS implemented a face-to-face rule for Medicare on July 1, 2013. The agency began enforcing a WOPD requirement on Jan. 1, 2014, but it has not begun enforcing the face-to-face visit requirement.

In states like Georgia, there was a face-to-face rule on the books for Medicaid even before Medicare implemented its rule. Physicians and providers in that state have been conducting and documenting face-to-face visits since 2011, soon after the ACA was enacted.

“It was a little tough in the beginning, because the physicians weren’t always mentioning their order and the need for it in their documentation, but it has gotten a lot better,” said Trish Clayton, revenue cycle manager for Barnes Healthcare Services in Valdosta. “It has been a training issue with physicians.”