Question: Is a Medicaid Face to Face Now Required in the Medicaid Hospice Program?
Disclaimer:The answers provided in this document are the result of the Texas and New Mexico Hospice Organization’s research and analysis. If you have specific questions on rules and our interpretation, contact the Texas Department of Aging and Disability Services’ Regional or State Offices.
NOTE: In the State of Texas a nurse practitioner does not exist nor is it allowed to be used per the BON. Using the term “nurse practitioner” is not in accordance with Board rules and is thus inappropriate. Current Board Rule 221.11 ( states that the APRN shall indicate that he/she is a registered nurse, including the appropriate advanced practice designation authorized by the Board. Display of educational distinctions and acquired certifications are optional. Board Rule 221.2 (b) ( further clarifies that “advanced practice nurse” shall not be used as a title (as it is not descriptive or specific to the role of population for which the APRN was educated). It is not in accordance with current Texas law for an individual to sign "Jane Doe, APRN" or "Jane Doe, FNP". In other words, it must be clear to the public that the nurse with advanced practice licensureis, in fact, an RN, with additional educational preparation and training specific to a population. Please note that the Board of Nursing does not specify the order in which the credentials must be signed.
Question: Is a Medicaid face to face now required in the Medicaid Hospice Program?
Answer: Yes, effective August 1, 2013, Medicaid Hospice requires a physician face to face assessment. It is required to be conducted up to 30 days prior to the begin date of the 2nd certification period and then for each certification period thereafter. DADS issued Information Letter #13-37 Addition of the Medicaid Hospice Physician Face-to-Face Assessment. You can access the letter at:
Question: Who can conduct the face to face in Medicaid hospice?
Answer: The hospice physician or a hospice advanced practice registered nurse (APRN) conducts the face to face.
Question:Is Medicaid going to accept the APRN visits for the face to face with the same process as Medicare? There is no mention of this in the information letterfrom DADS.
Answer:Yes, a face-to-face visit by the Hospice meets the Medicaid requirement.The APRN must be a W-2 employee. See 42 CFR 418.22.
Question: Dothe Medicare and Palmetto guidelines apply here?
Answer? Right now, the only difference is the Medicaid timeframes for doing the face to face assessment are the Medicaid certification periods.
Question: What happens when you sign someone onto Medicaidand they areMedicaid pending?Does DADS want the provider to begin the 30 day count from the date the Medicaid election form is actually signed?
Answer: Until an individual is Medicaid eligible, the Medicaid rules do not apply. Once eligible, the face to face assessment is required to be conducted up to 30 days prior to the begin date of the 2nd certification period and then for each certification period thereafter. The provider must use the service authorization dates seen on MESAV to determine the 30 days prior to the 2nd certification period.
Question: Is it possible to stay within the 30 day time frame for using the Medicare narrative.
Answer: That may not be possible in all situations.
Question:How do hospice providers handle face to face visits for new patients that were on a previous hospice? If they are transferring, and the election and certification are current, the provider does the update of the Form 3071 Individual Election/Cancellation/Update(Form 3071).Correct?
Answer: Yes, both the loosing and the gaining providers complete the Form 3071 as an Update. For an individual who transfers to another hospice provider, the gaining provider will look on MESAV and use the service authorization periods to determine the timeframe to complete their face to face assessment.
Question: If the face to face timeline is near and the transferring hospice did notcomplete the face to facethen is it the receiving hospice provider’s responsibility to complete it?
Response: Yes, in that situation it would be the responsibility of the receiving hospice provider.
Question: How should providers handle a person that was discharged from the previous hospice provider’s care and then elect onto the second hospice provider?
Answer: In a situation when the individual revokes hospice and the agency discharges the individual, then at a future date the individual elects hospice again, the six month certification periods start over with the new election.The requirement for the face to face assessment for the second agency begins with their second six month certification period as addressed in Information Letter #13-37 Addition of the Medicaid Hospice Physician Face-to-Face Assessment.The second agency is responsible to ensure all criteria are met at the time the individual (re)elects.
Question: What are the time frames for a face to face encounter?
Answer: Medicaid hospice follows the Medicare guidelines. The face to face encounter must occur sometime between the first day of the new certification period and thirty days prior to that date. If the face to face is performed on the day after the start of a new certification period, it would not be considered to have occurred in a timely manner. Additionally, re-certifications that require a face-to-face encounter, but which are missing the encounter are not complete. The statute requires a complete certification or recertification in order for Medicare to cover and pay for hospice services. Where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice’s failure to meet the face-to-face requirement, Medicare would expect the hospice to discharge the patient from the Medicare hospice benefit, but to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to re-establish Medicare eligibility. The hospice can re-admit the patient to the Medicare hospice benefit once the required encounter occurs, provided the patient continues to meet all of the eligibility requirements and the patient (or representative) files an election statement in accordance with CMS regulations.
The written certification itself may not be dated greater than 15 days prior to the start of the new certification. The written certification must be available within two days after the start of a new certification period. If not available a verbal certificationmustbe documented.
Question: What billing steps need to be taken if a face to face is missed?
Answer: The hospice is not able to bill for the days care is provided until the face to face assessment occurs. The Medicare Manual states: Re-certifications that require a face to face encounter but which are missing the encounter are not complete. The statute requires a complete certification or recertification in order for Medicare to cover and pay for hospice services where the only reason the patient ceases to be eligible for the Medicare hospice benefit is the hospice’s failure to meet the face to face requirement, Medicare would expect the hospice to discharge the patient from the Medicare hospice benefit, but to continue to care for the patient at its own expense until the required encounter occurs, enabling the hospice to reestablish Medicare eligibility. The hospice can readmit the patient to the Medicare hospice benefit once the required encounter occurs, provided the patient continues to meet all of the eligibility requirements and the patient (or representative) files an election statement in accordance with CMS regulations.
Question: What is the difference between the face to face and the physician’s narrative?
Answer: Both are required. The physician’s narrative must be completed for each certification periodand clearly identify the reasons the individual is considered terminally ill; and include clinical information that supports the medical prognosis. The face to face assessment, as described in IL 13-37 is part of the physician’s narrative as indicated in 42 CFR 418.22 Certification of Terminal Illness.
Question:Is a Medicaid face to face required for patients who have Medicare as primary but Medicaid for room and board only?
Answer: Yes, the face to face is required for dual eligibleindividuals; regardless of where they live.
Question: Medicare conducts many face to face visits compared to Medicaid. Adding Medicaid face to face visits is cumbersome and could easily overlap the Medicare face to face visits. Is DADS doing anything to try to lighten the load or will they consider the Medicare face to face visits sufficient for Medicaid’s visits?
Answer: The Affordable Care Act does not allow the State to make any changes in the certification periods until 2017. The Medicare face-to-face will suffice for the Medicaid face-to-face if they would occur within 30 days of each other.
Question: Who do I contact at DADS if I have a question about the face to face?
Answer: You can submit your questions via email to .
P.O. Box 1525, Austin, Texas 78767 1108 Lavaca, Ste. 727, Austin, TX 78701
1-800-580-9270 (512) 454-1247
FAX (512) 454-1248