Advocacy Alert: Congress Circulating Letter on Physician Face-to-Face Rule

Congressman Jim McGovern, along with Congressman Mike Ross of Arkansas, have circulated a sign-on letter to their colleagues in the US House of Representatives that urges CMS Administrator Donald Berwick to delay implantation of the physician face-to-face encounter rule.

Please contact your Congressperson and urge them to sign this letter and note that the deadline for signatures is Wednesday, December 15. The “dear colleague” letter and letter to Administrator Berwick is available below.

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Dear Colleague,

As you may be aware, the Centers for Medicare and Medicaid Services recently issued a Final Rule setting out various regulatory changes for the Medicare home health benefit.  One rule within the recent regulatory changes issued by CMS is intended to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. That rule implements a provision in the Affordable Care Act that requires face-to-face encounters between home health care patients and their physicians or certain non-physician practitioners. While this rule serves an important purpose, we are very concerned that neither the physician community nor the Medicare beneficiaries will be prepared for this change in time for meeting all the requirements by January 1, 2011.

We are asking members to cosign the following letter to CMS requesting a delay in implementation of the face-to-face requirement so that beneficiaries and providers have additional time to prepare for implementation of this new requirement.  If you would like to cosign, please e-mail Kate Callanan at kate.callanan@mail.house.gov.

Sincerely,

Mike Ross                                               James McGovern
Member of Congress                             Member of Congress

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Donald Berwick, MD
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Ave, SW

Washington, DC 20201

Re; Medicare Home Health Services
Physician Face-to-Face Encounter Requirements

Dear Dr. Berwick:

The Centers for Medicare and Medicaid Services recently issued a Final Rule setting out various regulatory changes for the Medicare home health benefit. As you are very aware, home health services is one of the most important benefits in the Medicare program as it is a very viable solution for Medicare’s increasing costs, allowing people to recover at home and thereby reducing spending for higher cost care such as hospitalizations and institutional care. At the same time, we are cognizant of the need to manage that crucial benefit with high integrity.

One rule within the recent regulatory changes issued by CMS is intended to maintain benefit integrity by ensuring strong physician involvement in care planning and authorization. That rule implements a provision in the Affordable Care Act that requires face-to-face encounters between home health care patients and their physicians or certain non-physician practitioners. While this rule serves an important purpose, we are very concerned that neither the physician community nor the Medicare beneficiaries will be prepared for this change in time for meeting all the requirements by January 1, 2011.

We understand that CMS has not initiated any educational efforts yet directed to physicians and Medicare beneficiaries on this new rule. The rule is not simple. It is complicated for both doctors and their patients to fully understand. The consequence of a patient’s noncompliance with the rule is severe as Medicare benefits will be denied. However, even if CMS begins to educate everyone affected by this rule immediately, we strongly suspect that the message will not get through in time.

We urge you to establish a plan of action to transition this new requirement into operation rather than fully enforce it on January 1. That transition should include a well planned and executed education campaign, the issuance of comprehensive guidelines to address existing ambiguities in the rule, and a trial period where compliance with the rule is monitored and appropriate adjustments made before denying Medicare benefits to a patient who does not have the qualifying encounter. Further, we request that you schedule a meeting with us and representatives from the physician, beneficiary, and home health agency community to plan that transition.

Given the short time before this rule becomes effective, we respectfully request your immediate attention to this matter.

Thank you for your time and consideration.

Sincerely,

Return to www.thinkhomecare.org.

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