Medicaid will require face-to-face doctor visits for beneficiaries to receive home health services, medical equipment

January 26, 2016

Beginning July 1, physicians must document a face-to-face encounter with a patient to validate Medicaid coverage for home health services and medical equipment. The final regulations come nearly five years after the CMS first proposed the policy under a provision of the ACA. To validate the need for coverage under the rule, a physician must document a face-to-face encounter took place no more than 90 days before or 30 days after the start of services. For a patient to get medical equipment, a physician or authorized provider must document that an encounter took place no more than six months before the equipment was received. The rule does not apply to Medicaid managed care. The CMS said it is deferring to states to determine the application of the face-to-face requirement in managed care plans to best meet the needs of their beneficiaries.