powered by LeadingAge New York

DOH Posts F2F Encounter Guidance for Medicaid Home Health Cases

In the July 2017 New York State Medicaid Update, the Department of Health (DOH) outlines guidance on implementing the requirements for the face-to-face (F2F) encounter with Medicaid providers for the initial authorization for home health services provided by a Certified Home Health Agency (CHHA) and certain durable medical equipment (DME) ordered with these services. LeadingAge NY had requested this guidance from DOH before the mandated implementation of July 1st. This a federal requirement, but the state is charged with implementing the F2F requirement, providing guidance, and enforcing the requirement. There has been concern voiced from CHHA members on their exposure to this requirement without guidance from the state. The F2F requirement already applies to Medicare home health services.

Included in the Medicaid Update are the F2F rule requirements for physicians, authorized non-physician practitioners (NPPs), home health agencies, and durable medical equipment providers as applied to Medicaid, as well as guidance for compliance.

Please note: the F2F encounter rules for Medicaid home health cases only apply to Medicaid fee-for-service (FFS) coverage serviced by CHHAs. The CHHA must maintain a copy of the F2F documentation in the clinical record.

F2F rules are not applied to managed care cases, or to cases that are personal care service-only.

Included in the Update are:

  • All the F2F requirements under 42 CFR § 440.70;
  • Certification of patient eligibility for Medicaid home health services;
  • F2F requirements for DMEs; and
  • Payment for F2F Encounter Services and DMEs.

DOH also included the CMS Fact Sheet regarding the rule.

If you have Medicaid program questions, please contact the Office of Health Insurance Programs, Division of Program Development and Management at 518-473-2160.

If you have Medicaid billing questions, please contact eMedNY Provider Services at 800-343-9000.

General questions can be directed to the Office of Primary Care and Health Systems Management, Division of Home and Community Based Services at 518-408-1638 or homecare@health.ny.gov.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871