Coming soon: Face-to-face requirement for both Medicare, Medicaid

Thursday, July 7, 2011

BALTIMORE - CMS moved closer to establishing a face-to-face requirement for home medical equipment under Medicaid with a proposed rule issued July 5.

The proposed rule, required under the Affordable Care Act (ACA), would require physicians ordering home health services or HME under Medicaid to document that a face-to-face exam has taken place.

"The overall intent is to be consistent between (Medicare and Medicaid)," said Asela Cuervo, a Baltimore-based healthcare attorney. "For example, the same types of DME will be subject or not subject to the requirement under both programs."

The ACA also required that CMS require face-to-face exams under Medicare. In April, CMS implemented the requirement for home health services, but so far, it has not issued a similar rule for Medicare.

That's what made last week's rule a bit confusing. It contained several references to the Medicare requirement, even though it does not yet exist.

"It's sort of like they are waiting for the Medicare guidance to drop," said Cara Bachenheimer, senior vice president of government relations for Invacare. "I thought it was extraordinarily unclear."

The rule also contains several clarifications related to DME under the Medicaid program: 

* It would modify the phrase "suitable for use in the home" to "suitable for use in any non-institutional setting in which normal life activities take place."

* It also proposes to better align Medicaid with Medicare's definition of HME. 

One potentially positive note in last week's rule: The requirement could exclude certain "small dollar" items and those at low risk of fraud, waste and abuse.

"That's encouraging," said Bachenheimer. "The question is: What will it be applied to?"