New Medicare Rule Calls for Face-to-Face Encounter with Physician for Hospice/Home Health Benefits

New Medicare Rule Calls for Face-to-Face Encounter with Physician for Hospice/Home Health Benefits

A new federal regulation issued by Medicare in November as part of health care reform’s Affordable Care Act will affect approximately 4.5 million beneficiaries receiving home health and/or hospice benefits. Starting on January 1, homebound elderly and disabled patients as well as hospice patients will require having a “face-to-face encounter” with a physician or nurse practitioner if they want to receive care under Medicare. For hospice patients, this “encounter” must happen prior to the 180th day recertification for continued hospice benefits and for each subsequent recertification. The certifying hospice physician must also attest that such a visit took place.

The intent of the new rule is to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. Yet advocates are strongly encouraging Medicare to examine the implementation process. They advise having a transitional period of no less than 6 months after the rule is enacted, wherein Medicare can monitor for compliance, provide notice of noncompliance where appropriate, provide continuing education on the requirements, and institute changes in instructions and guidelines where needed.

Advocates are concerned about possible disruptions in access to hospice and home health care as most likely most affected people, doctors included, have not heard of the new rule yet.

Elderly and disabled Medicare beneficiaries who are confined to their homes for medical reasons or hospice patients in the midst of end of life care will need to find a way to either get to the doctor or get the doctor to come see them. This is the predicament that will result if considerations for home care and hospice needs are not made.

You can read the full text (PDF) of the new Medicare rule.

This article was edited in part from a National Association for Home Care and Hospice press release.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.