There has been conflict and confusion in statute, regulation, and manual instructions when it comes to Medicare coverage policies for home health agencies. NAHC recently sought clarification.
What Happened
The CARES Act allowed for more flexibility than the regulations in who could conduct a face-to-face encounter, however, the regulations and manual instructions were not updated to reflect the flexibility. All three of the Medicare Administrative Contractors continue to follow the procedure in the Medicare Benefit Policy Manual on F2F encounters (chapter 7, section 30.5.1.1) — at least until CMS revises the regulations and manual instructions to conform with the CARES Act.
When it comes down to who can perform a F2F encounter, non-physician practitioners include nurse practitioners, certified nurse midwives, and physician assistants all in accordance with State law/regulations and collaborating/under the supervision of a certifying physician. HHAs can accept orders from multiple physicians and nurse practitioners, physician assistants, and clinical nurse specialists (i.e. allowed practitioners).
What This Means
The short is that unless the patient is admitted directly from an acute or post-acute care facility, the establishing physician or allowed practitioner or a physician or allowed practitioner from the original’s same group practice can sign the certification or recertification.
The long is, if not the physician or allowed practitioner, another physician or allowed practitioner in the same group practice as the certifying physician or allowed practitioner who established the home health POC may sign in the place of the original if they are not available. However, the physician or allowed practitioner who performed the F2F encounter must sign the certification of eligibility, unless the patient is directly admitted to home health care from an acute or post-acute care facility and the encounter (F2F) was performed by a physician or allowed practitioner in such a setting.
But Wait, There’s More
CMS has clarified that the statutory changes address home health benefits under Medicaid and not the private duty nursing benefit — so as of now, it seems as though NPPs are not allowed to order private duty nursing.
It is worth noting that HHAs are ultimately responsible for the POC, which includes communication with all of the physicians and allowed practitioners involved in the POC. This again extends to physicians and allowed practitioners who are authorized to act in the absence of the main physician or allowed practitioner.
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Source
homecaremag.com