The Centers for Medicare & Medicaid Services (CMS) last week published a final rule that requires physicians to document face-to-face encounters with Medicaid patients for the authorization of home health services, yet the final rule also approves the use of telehealth for such face-to-face visits.
In a fact sheet about the final rule, CMS stated, that “this rule aligns with Medicare to the greatest extent possible which will help to streamline beneficiaries’ access to needed items and maximize consistency in service delivery, as well as reduce administrative burden on the provider community.”
The final rule also requires physicians or authorized non-physician practitioners (NPPs) to document the occurrence of a face-to-face encounter for the ordering of related medical supplies, equipment and appliances, and the use of telehealth extends to this as well.
And, the rule extends the timeframe for the face-to-face encounter to no more than 90 days before the start of services and up to 30 days after the start of services.
In the final rule, CMS also outlined how allowing the use of telehealth for the face-to-face encounter addresses some concerns that were voiced during the comment period for the proposed rule. There were some public comments to the proposed rule indicating concerns that the face-to-face encounter requirement would be a barrier to timely care for homebound individuals and impede access to necessary home health care.
CMS stated in the final rule, “We recognize that some individuals may have difficulty meeting the face-to-face requirement. We believe we have accounted for these circumstances while meeting statutory requirements, by extending the timeframe of the face-to-face encounter to 30 days after the start of home health services, by allowing for NPPs to complete the face-to-face encounter, and by encouraging telehealth as an alternative for ensuring that this new requirement is implemented in a way that protects continuity of services.”
CMS did not specifically outline what kinds of telemedicine technologies were acceptable, but did state that telephone calls and emails were not acceptable as a replacement for the face-to-face encounter. And, CMS said it would defer to state definitions of telehealth and telemedicine.
The agency also said updated Medicaid telehealth guidance would be “forthcoming.”
“In the absence of specific Medicaid statutory requirements, we are hesitant to proscribe the locations and/or technologies that states may use to meet the face-to-face requirement through telehealth. Under Medicaid policy, states have the flexibility to define coverage of telehealth including what types of telehealth to cover; where in the state it can be covered; and how it is provided,” CMS stated. "Our expectation is that care delivered using various technologies will lead to good outcomes and meet the needs of the individual while adhering to privacy requirements, including the requirements under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)."
Some states have provisions for reimbursing transportation costs to facilitate providers' face-to-face encounters with Medicaid patients. And, in response to public comments requesting clarification on Medicaid coverage of telehealth equipment, facilities and transportation costs, CMS noted that state Medicaid agencies could "build reimbursement for the costs into the rate."
"Medicaid does not reimburse for telecommunications equipment or facility costs separately. However, states could build reimbursement for the costs into the rate and states can include in the rate a separate amount for such costs. Reimbursement for services provided through telehealth is voluntary on the part of state Medicaid agencies as they are viewed as alternative methods of providing services, not as a separate type of service. Therefore, reimbursement is only available if the state has chosen to cover services provided via telehealth or telemedicine and only in the circumstance selected by the state," CMS stated.