Hom e H Healt h Service ces and Fa Face-t o-Face Encount er - - PowerPoint PPT Presentation
Hom e H Healt h Service ces and Fa Face-t o-Face Encount er Requirem ent s Guest Presenters Alexandra Koloskus, JD Matt Colussi June 2017 Our r Mission I mproving health care access and outcomes for the people we serve while
Guest Presenters – Alexandra Koloskus, JD Matt Colussi June 2017
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services, physical therapy, occupational therapy, and speech/language pathology services that are provided by a licensed and certified Home Health agency.
intermittent skilled care in their place of residence or in the community.
surgical care) for up to 60 days without prior authorization.
day Acute Home Health period. Long-Term Home Health services require prior authorization.
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Tool (PAT) and the client’s plan of care.
periods.
Acute Home Health episode.
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Utilization & Expenditure Trends – Fiscal Years 2011 - 2015 Statistics FY 12-13 FY 13-14 FY 14-15 FY 15-16 Total Medicaid Clients 808,100 1,109,853 1,338,330 1,440,312 Total Expenditures $177,039,478 $207,317,907.20 $244,525,640.10 $276,181,802.47 Total Number of Clients Utilizing Benefit 13,190 15,845 18,962 20,813 Number of Providers 150 152 153 167 Acute Home Health Expenditures $18,779,047 $23,081,327.63 $30,893,384.77 $32,703,502.53 Long-Term Home Health Expenditures $158,181,727 $184,155,594.04 $213,543,191.91 $243,382,023.80 LTHH CNA Expenditures $115,023,319 $129,285,429.17 $147,780,736.30 $169,269,623.21 LTHH All Other Expenditures $43,158,408 $54,870,164.87 $65,762,455.61 $74,112,400.59 Number of Pediatric Clients Served (Ages 0-20) 4,290 5,510 6,449 7,402 Pediatric Expenditures $87,740,366 $90,235,982.04 $125,680,438.74 $149,695,107.39 Telehealth Expenditures $10,314.67 $20,122.70 $22,579.50 $9,044.54
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Guest Presenters – Alexandra Koloskus, JD Matt Colussi
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Health service definition consistent with section 6407 of the Affordable Care Act to add two basic requirements: 1. For Home Health services, physicians or certain federally authorized non- physician practitioners (NPPs) document the occurrence of a face-to-face encounter with the Medicaid-eligible beneficiary within specific time frames. 2. Home Health services may not be limited to services furnished in the home and can now be provided in the community.
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For the initial ordering of Home Health services: I. The Ordering Physician must document the occurrence of a face-to-face encounter II. The encounter must be related to the primary reason the client requires Home Health services
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all episodes initiated with the completion of a start-of-care OASIS assessment on or after July 1, 2017.
services.
face-to-face visit (they will be ‘ grandfathered’ in).
from Medicare to Medicaid, and a face-to-face encounter was performed at the start of Home Health services, a new face-to-face encounter is NOT required.
Medicaid F2F requirement
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Federally authorized practitioners include:
enrolled with Health First Colorado.
which the patient was directly admitted to home health).
(1) A nurse practitioner (NP) or clinical nurse specialist (CNS) who is working in collaboration with the ordering physician or the acute/post-acute care physician; (2) A certified nurse midwife; (3) A physician assistant (PA) under supervision of the ordering physician.
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The face-to-face encounter must be documented on the ordering physician’s plan-of-care and must include:
encounter.
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Clients discharged from a hospital to Home Health services are not required to receive a
separate face-to-face encounter, as long as a physician or allowed NPP performs the face-to- face encounter in the hospital and communicates the clinical findings of the face-to-face encounter to the ordering physician in the community.
Clinical findings can be communicated in the form of clinical and progress notes and discharge summaries.
“There is no federal prohibition on a NPP documenting the face-to-face encounter and having
the physician sign the documentation.”
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Final Federal Rule Clarifies: I. Medicaid Home Health services cannot be restricted to homebound individuals II. Medicaid Home Health services can be provided outside of the home and in the community when the client is participating in normal life activities I. Other than in a hospital, NF, ICF-ID or any setting in which payment could be made under Medicaid for inpatient services that include room and board.
Utilization Review mechanisms still apply (LTC evaluations and Pediatric Assessment Tool)
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from medical appointments.
state.co.us
procedure codes. Health First Colorado anticipates that the visits will be reimbursable
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including HHIC, and to move BCS content into rule.
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gap between current rates and LUPA (Low Utilization Payment Adjustment).
s- HH and PDN rates increased by 1/ 3rd of the gap between current rates and LUP A
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