New Rule Requires Homebound Medicare Patients to See Doctors

Medicare patients typically receive home care services because it is difficult or impossible for them to leave their homes. But the Centers for Medicare and Medicare Services (CMS) has now implemented a new Medicare requirement that doctors must meet face-to-face with their patients who are receiving home health care in order for the patient's home health visits to be reimbursed.

Under the requirement, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services. The move is aimed at reducing unnecessary Medicare home health care, which doubled to $19 billion from 2002 to 2009. The rule also applies to hospice patients, who by definition have been determined to have only six months to live. The face-to-face visit can be with a non-physician practitioner such as a nurse practitioner or a physician assistant, but a supervising doctor must sign the certification for the encounter.

Groups representing the home health and hospice industries say requiring face-to-face visits will create a severe hardship for some homebound frail seniors and patients who live in rural areas. Under the former law, doctors had to prescribe home health care for Medicare recipients to receive services, but they were not required to see the patients in person.

"This poses a burden that is impossible to comply with," said Val Halamandaris, president of National Association for Home Care & Hospice. He predicted a coming "train wreck" as a result of the new rule.

The face-to-face visit requirement, a part of the new health reform law, was to take effect January 1, 2011, and would have called for physicians to see patients within 30 days before or two weeks after the start of home care. But after complaints from providers, CMS delayed implementation for three months and expanded the timeframe for doctor visits. Provider groups and the AARP pressed CMS for another three-month extension, to no avail. They now will be looking to Congress for a legislative solution.

For more information about the new rule, see Section 30.5.1 of the Medicare Benefit Policy Manual at: http://www.cms.gov/manuals/Downloads/bp102c07.pdf (thanks to the Medicare Rights Center for providing this link.)