What We’re Watching For: Changes in Medicare Home Health Regulations That Affect Your Practice

In light of geriatric patients’ vulnerability to COVID-19, physicians in small and solo practices are looking for Medicare-approved alternatives to office visits. Unfortunately, not every patient is a great candidate for telemedicine. Are house calls the answer? We discuss the state of the current regulations.

Currently, CMS Medicare regulations restrict the ability of physicians to provide home care to new or existing patients. These regulations require physicians to be affiliated with a Home Health Agency (HHA), require patients to be “homebound” before providing home health care, and require the visit between the patient and physician to be “face to face.” However, in the face of the ongoing COVID-19 pandemic, advocates are urging CMS to re-think these requirements and allow physicians to care for their elderly or higher-risk patients in the safety and comfort of their homes. 

The “Homebound” Patient Requirement 

Under Medicare regulations, a “homebound patient” is an individual that has been certified by a doctor as being “homebound” and has trouble leaving their home without help because of an injury or illness. For example, this patient may need to use a wheelchair or crutches to get around and leaving the house requires a major effort. 

In the case that CMS waives this strict requirement, physicians would have the freedom to make house calls for patients that have been advised to stay home during this public health crisis. These patients could be elderly individuals, or patients who are unable to receive care through traditional telehealth methods. 

Affiliating With a Home Health Agency (HHA)

The restrictive requirement that treating physicians be affiliated with a HHA before visiting a patient for in-home care limits the number of physicians able to provide and be properly reimbursed for house calls. 

To expand the number of physicians able to visit patients in their homes and receive reimbursement for the provided care, CMS should waive the requirement that physicians need to be affiliated with a Medicare-certified HHA. 

The “Face to Face” Requirement

This “face to face” requirement mandates that physicians and patients see one another in-person during a reimbursable home visit rather than allowing a visit to take place over the phone or other telehealth methodologies. Frustratingly, this requirement is more restrictive than many states’ laws regarding the use of telemedicine to initiate a new patient relationship, and it puts Medicare beneficiaries, homebound patients, or those without access to telehealth technologies at a disadvantage. (See our blog about initiating a new patient relationship via telehealth.)

In an effort to prevent the spread of any contagious disease, and protect physician health, CMS should waive this requirement. As providers prepare for a potential increase in home care patients, expanding a patients’ ability to access their treating physician is imperative to early intervention methods that may prevent or slow the spread of illness. 

For guidance about a specific circumstance or question regarding your practice and house calls, consult the experienced attorneys at Jackson LLP, who serve independent practices of all types in Illinois, Wisconsin, Michigan, Connecticut, Florida, and California.

The COVID-19 pandemic is a dynamic and evolving public health emergency. The laws and situation are fluid, and this article may not reflect the most current situation.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

Free Attorney Consultation

Book Now