Date: July 7, 2017
To: Enrolled Home Health Agencies; Durable Medical Equipment and Supplies Providers; Physicians; and Advanced Practice Nurses
Re: Changes to the Face-to-Face Encounter Requirements for the Initial Ordering of Home Health Services; New Face-to-Face Encounter Requirements for the Initial Ordering of Durable Medical Equipment (DME) under the Home Health Benefit
The February 2, 2016 Federal Register Final Rule by the Centers for Medicare and Medicaid Services (CMS) revises 42 CFR Part 440.70 and implements changes impacting State Medicaid home health programs. Illinois administrative rule amendments are in process and these changes will be effective for dates of service beginning July 1, 2017.
Home Health Face-to-Face Encounter Requirements
· The clinical findings of the face-to-face encounter must be incorporated into a written or electronic document in the patient’s medical record.
· Home Health Aide services will also require a face-to-face encounter.
DME Face-to-Face Encounter Requirements under the Home Health Benefit
· A face-to-face encounter, which is related to the primary reason the patient requires medical equipment, supplies or appliances, must occur no more than six months prior to the start of services. An order for DME and supplies is valid for one year. A new face-to-face encounter will be required if a new order is written for DME and supplies.
· The face-to-face encounter must be performed by the certifying physician, a nurse practitioner or clinical nurse specialist who is working in collaboration with the physician in accordance with State law, a physician assistant under the supervision of the physician, or, for patients admitted to home health immediately after an acute or post-acute stay, the physician who cared for the patient in an acute or post-acute facility.
· If the certifying physician does not perform the face-to-face encounter personally, the non-physician practitioner or the physician who cared for the patient in an acute or post-acute facility performing the face-to-face encounter must communicate the clinical findings of that face-to-face patient encounter to the certifying physician. The clinical findings must be incorporated into a written or electronic document in the patient’s medical record.
· The certifying physician must document the face-to-face encounter is related to the primary reason the patient requires medical equipment, supplies or appliances, and occurred no more than six months prior to the delivery of the item. The documentation must indicate the practitioner who conducted the encounter and the date of the encounter.
Both the physician certifying the face-to-face encounter and the medical equipment provider supplying the item are responsible for retaining a copy of the certification for audit purposes.
For the items requiring the face-to-face encounter, a Doctor of Medicine or Doctor of Osteopathic Medicine must write the order for the item per 42 CFR Part 440.70.
Submitting Face-to-Face Encounter Certification with Prior Approval Requests for Medical Equipment and Supplies
For items requiring prior approval, the medical equipment provider must include documentation of the face-to-face encounter certification as part of the packet submitted to the Department for approval of the item.
DME Fee Schedule
CMS has emphasized that while a state may post a medical equipment and supplies fee schedule of coverable items, the fee schedule cannot be interpreted as an absolute list. Providers may submit approval requests on a patient’s behalf for any item not on the fee schedule but believed to be medically necessary in the particular circumstances. To verify medical necessity of the requested item, the medical equipment provider must submit documentation of a face-to-face encounter certification with the request for approval.
Questions may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood