Two weeks ago in The Source, LeadingAge Ohio included a You Asked, We Answered question about needing a Face to Face (F2F) encounter for Medicaid primary recipients. The answer was, as of October 1, 2017, hospice providers do need to be obtaining a F2F encounter for Medicaid-primary recipients going into their third or later benefit period.
The Ohio Department of Medicaid (ODM) hospice rule 5160-56-02 was updated on October 1, 2017, and (A)(1) states:
“To be covered under Ohio Medicaid, the designated hospice must ensure the following criteria are met prior to furnishing hospice care. The designated hospice has a certification of the terminal illness on behalf of the individual, obtained in accordance with 42 C.F.R. 418.22 (October 1, 2017).”
With the federal Condition of Participation referenced at the end of the citation, it indicates that Medicaid-primary hospice patients need to meet the Medicare Condition of Participation for Certification of Terminal Illness, including a F2F encounter when recertifying a patient into their third or later benefit period. A F2F encounter for Medicaid primary patients was not necessary prior to October 1, 2017.
Realizing some hospices may not have known that they should have been obtaining a F2F encounter on Medicaid primary recipients, LeadingAge Ohio reached out to the Hospice Policy Administrator at ODM to inquire what a hospice should do related to billing if they have not secured a F2F encounter on a Medicaid primary patient.
The ODM Hospice Policy Administrators response was, “Moving forward, they (hospices) should make sure that they have the proper certification of terminal illness in accordance with 42 C.F.R. 418.22, including the F2F encounters. They can still bill for those dates however; they are at risk of having money taken back if an auditing entity decides to do an audit and determines that they are out of compliance.”
Questions related to this issue should be directed to Anne Shelley, Director of Regulatory Affairs for Home Health & Hospice at firstname.lastname@example.org.