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New Face to Face Encounter Requirements Released by Medi-Cal

Posted on Thursday, March 22, 2018 4:03 PM

For all services delivered by a home health agency, a face-to-face encounter with a physician, nurse practitioner, clinical nurse specialist, physician assistant, or certified nurse midwife that is related to the primary reason the recipient requires the home health services is required.  Face-to-face encounters may be done via telehealth.

The following conditions must be met in order for the face-to-face encounter to be satisfied:

  • The provider performing the face-to-face encounter must communicate the clinical findings of that face-to-face encounter to the ordering physician.
  • The clinical findings from the face-to-face encounter must be incorporated into a written or electronic document included in the recipient's medical record.
  • The physician prescribing the home health agency services must document that the face-to-face encounter, which is related to the primary reason the recipient requires services by a home health agency, has occurred within 90 days prior to or within 30 days after the start of services.
  • The physician writing the prescription for home health agency services must document who conducted the face-to-face encounter and the date of the encounter.

DHCS ANNOUNCEMENT ON FACE TO FACE ENCOUNTER FROM MARCH 6 Effective for dates of service on or after July 1, 2017, Code of Federal Regulations (CFR) Title 42, Section 440.70 requires Medicaid programs to require a face-to-face encounter prior to delivery of services by a home health agency.

The face-to-face encounter must be administered by a physician, nurse practitioner, clinical nurse specialist, physician assistant or certified nurse midwife and must be related to the primary reason the recipient requires home health services. Face-to-face encounters may be done via telehealth. The encounter must occur within 90 days before or within 30 days after the start of services. If the provider performing the face-to-face encounter is not the physician, the provider must communicate the clinical findings of that face-to-face encounter to the ordering physician.

Source: CAHSAH


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