CMS implements new law on hospice, home health

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The Centers for Medicare & Medicaid Services has begun implementing a new law that requires physicians to meet face-to-face with individuals looking to be certified for Medicare home health services and Medicare hospice services.

While the law went into effect January 1 under the Affordable Care Act, CMS allowed a three-month delay to give struggling agencies more time.

The rule requires the healthcare professionals who make certification decisions to provide documentation saying they met with the patient in person. The encounter for home health must  occur within the 90 days prior to the start of care, or within the 30 days after the start of care.  Similarly, a hospice physician or nurse practitioner to have a face-to-face encounter with a hospice patient prior to the patient's 180th-day recertification, and each
subsequent recertification.  The encounter must occur no more than 30 days prior to the start
of the hospice patient's third benefit period.

During the first quarter of 2011, CMS conducted outreach efforts to teach providers how to comply with the new requirements, and worked with local and state officials to ensure awareness.

Still "the regulations set a standard with which it is impossible to comply," said Val J. Halamandaris, president of The National Association for Home Care and Hospice. "Physicians do not have the time, nor would they be compensated for traveling many miles to see homebound patients. They're more likely to choose the easier route, which is to keep patients in the hospital or refer them to another institutional care setting."

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