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The Center for Medicare and Medicaid Services (CMS) recently issued a memorandum clarifying a previous statement found in the final call letter for the 2015 rates for the Medicare Advantage (MA) plans. Previously, CMS stated that the MA plans were to apply the same certification requirements as fee-for-service (FFS) Medicare to plan members who receive home health services and directive would also require that the plans apply the F2F encounter requirement.

The new memorandum issued June 11 clarifies “an MAO's authorization for home health services may substitute for the Original Medicare face-to-face certification requirement for the authorization of home health care services.”

CMS issued the following memorandum to the Medicare Advantage plans on June 11, 2014:

This memorandum is to correct the Final Call Letter of April 7, 2014 regarding Medicare Advantage organization's (MAO's) certification of enrollees for home health services. We are clarifying that an MAO's authorization for home health services may substitute for the Original Medicare face-to-face certification requirement for the authorization of home health care services.

In certain circumstances, MAOs are not required to follow Original Medicare documentation requirements for the provision of Medicare covered services, but may substitute methods they deem appropriate for ensuring that the services provided are medically necessary, so long as they are not more restrictive than the coverage standards that apply in Original Medicare.

 

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