PDF Version
TO: Physicians, Certified
Registered Nurse Practitioners, Physician Assistants, Durable Medical Equipment
(DME) and Home Health Providers
Chapters
14, 17, 21, 28, and Appendix O to the Alabama Medicaid Agency’s Provider Manual
are being updated to inform providers that, effective August 01, 2018, in
accordance with 42 C.F.R. § 440.70, the initial written prescription/order for
home health services and certain medical supplies, equipment, and appliances
must be signed and placed by the physician who develops the recipient’s written
plan of care (“the ordering physician”) after the required face-to-face visit
is conducted and documented by an authorized practitioner.
Requirements for Placing the Initial Written
Prescription/Order for Certain Medical Supplies, Equipment, and Appliances
Effective August 01, 2018,
in accordance with 42 C.F.R. § 440.70, the initial written prescription/order
for certain medical supplies, equipment, and appliances must be signed and
placed by the physician who develops the recipient’s written plan of care (“the
ordering physician”). The ordering physician may only place the initial written
prescription/order after the required face-to-face visit is conducted and documented by an authorized practitioner. Subsequent written prescriptions/orders for
refills, ancillary supplies, repairs or services, or re-certifications do not
require the ordering physician’s signature or an additional face-to-face visit.
Not all initial written
prescriptions/orders for medical supplies, equipment, and appliances require a
face-to-face visit be conducted. The face-to-face visit requirement is limited
only to the certain medical supplies, equipment, and appliances that are also
subject to a face-to-face requirement under the Medicare DME program as
“Specific Covered Items.” The following link from CMS provides a list of the
DME codes for Specific Covered Items that are subject to the face-to-face visit
requirements under the Medicare DME program:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/FacetoFaceEncounterRequirementforCertainDurableMedicalEquipment.html.
The required face-to-face
visit for the initial written prescription/order for certain medical supplies,
equipment, and appliances must be related to the primary reason why the
recipient requires the medical supplies, equipment, and appliances and must
occur no more than six (6) months prior to the start of services.
The required face-to-face
visit for the initial written prescription/order for certain medical supplies,
equipment, and appliances may be both conducted
and documented by an authorized
practitioner. An authorized practitioner
includes the ordering physician and the following authorized non-physician practitioners
(NPP):
•
Certified registered nurse practitioners or clinical nurse specialists
working under a collaboration agreement under Alabama law with the ordering
physician;
•
Physician assistants under the supervision of the ordering physician;
and
•
Attending acute or post-acute physicians, if recipients are admitted to
home health services immediately after discharge from an acute or post-acute
stay.
The ordering physician is
also required to review the recipient’s written plan of care annually to determine
the recipient’s continued need for all medical supplies, equipment, and
appliances.
DME providers are also required to
maintain all such written or electronic documentation in the recipient’s
medical records.
Refer to Chapter 17—Home
Health for more information on the requirements for placing the initial written
prescription/order for home health services.
Requirements for Placing the Initial Written Prescription/Order for Home
Health Services
Effective August 01, 2018, in
accordance with 42 C.F.R. § 440.70, the initial written prescription/order for
home health services (i.e., nursing services and home health aide services)
must be signed and placed by the physician who develops the recipient’s written
plan of care (“the ordering physician”). The ordering physician may only place
the initial written prescription/order after the required face-to-face visit is
conducted and documented by an authorized practitioner. Subsequent written prescriptions/orders for
refills, ancillary supplies, repairs or services, or re-certifications do not
require the ordering physician’s signature or an additional face-to-face visit.
The required face-to-face visit
for the initial written prescription/order for home health services must be
related to the primary reason why the recipients require the home health
services and must occur within the 90 days before or within the 30 days after
the start of the services.
The required face-to-face visit
for the initial written prescription/order for home health services may be conducted by an authorized
practitioner. An authorized practitioner
includes the ordering physician and the following authorized non-physician
practitioners (NPP):
- Certified
registered nurse practitioners or clinical nurse specialists working under a
collaboration agreement under Alabama
law with the ordering physician;
- Certified
nurse midwifes under applicable Alabama law;
- Physician assistants under the supervision
of the ordering physician; and
- Attending
acute or post-acute physicians, if recipients are admitted to home health
services immediately after discharge from an acute or post-acute stay.
The NPP must then communicate the clinical findings of
the face-to-face visit to the ordering physician. The ordering physician must then document those findings in the
recipient’s medical record.
The ordering physician is also
required to review the recipient’s written plan of care every sixty (60) days
to determine the recipient’s continued need for home health services.
Home health service providers are
also required to maintain all such written or electronic documentation in the
recipient’s medical records.
Refer to Chapter 14—Durable
Medicaid Equipment (DME), Supplies, Appliances, Prosthetics, Orthotics and
Pedorthics (POP) for more information on the requirements for placing the
initial written prescription/order for certain medical supplies, equipment, and
appliances.
The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 2017 American Medical
Association and © 2017 American Dental Association (or such other date publication of CPT
and CDT). All rights reserved. Applicable FARS/DFARS apply.