NH Health Care a United Front on F2F

New Hampshire health care providers have joined together in asking the Centers for Medicaid and Medicare Services (CMS) to reconsider how it interprets the Medicare home health Face to Face encounter requirements in the Affordable Care Act.  In a letter sent to CMS on Friday, four provider associations voiced their frustration with regulations that often result in care delays for eligible patients.  New Hampshire’s providers maintain the additional documentation is excessive, redundant, hinders access to care and does nothing to promote quality or cost savings.

Since January, home care agencies in New Hampshire and across the country have experienced an increase in the number of Face to Face Additional Documentation Requests and denials. As a result, the long-simmering frustration over CMS’s interpretation of the F2F encounter requirement has reached a boiling point. A variety of advocacy efforts are underway.

Last week the Home Care Association of New Hampshire co-signed a letter to CMS Administrator Marilyn Tavenner with the NH Medical Society, NH Hospital Association and NH Medical Group Managers Association. The letter voices concerns, asks for a suspension of Additional Documentation Requests (ADRs) and denials, and recommends elimination of the physician’s “brief narrative” of the F2F encounter.

The National Association of Home Care and Hospice has also taken up the Face to Face documentation issue by submitting a lawsuit challenging the practice.  The lawsuit, which NAHC intends to file in Federal District Court in Washington, D.C. later this week, includes three claims:

  • CMS does not have the authority to require patient narratives as the authorizing statute passed by Congress only requires a physician to document that a face-to-face visit occurred;
  • To the extent that CMS can require the narratives, the Constitution and Medicare law require CMS to create reasonable and comprehensible standards for compliance; and
  • Medicare cannot deny a claim solely based on face-to-face encounter documentation.

The home health care providers maintain the rule is being interpreted unfairly, and doctors find the parameters for writing a permissible narrative vague and confusing.

Additionally, the Forum of State Associations, led by the Home Care Association of New York State, is attempting to have clarifying F2F language included in federal appropriations legislation. While adoption of the language is unlikely in the Senate, key members of the House have been receptive to the effort.