CMS has included several changes to the Face-to-Face Provision in the Proposed Rule for 2015 HH PPS.  One that is definitely needed, one that could impact the referral source (albeit minimally, when compared to the impact to HH), and one that has the potential to be worse that what we are currently dealing with.

We agree that the Narrative as it is currently being utilized and reviewed should be eliminated!  And we agree that the referral source should have some responsibility and liability in the establishment of 1) Homebound and 2) Need of Skilled Care; however, the disparity proposed is ridiculous; and in a manner of speaking, haven’t they always had this through their certifying the home health plan of care?  Regarding financial liability, thereferral source is liable for 15 to maybe 30 minutes of reimbursement for their responsibility, while the HHA has a liability for 60-days of service; which will be in the $1,000s and can be in the $10,000s.  How is that even remotely reasonable?  Were the members of Congress that voted for this aware of how this was going to be applied and implemented?

Conceptually, this was not a bad idea, but seems redundant as the referral source is in effect certifying the above each and every time they sign a Plan of Care.  Believe me; the vast, vast, vast, vast, vast majority of us in home health want to stamp out fraud too.  But using a wrecking ball approach to something that should be done with a scalpel is not a reasonable way to go about doing this.  Here you have an opportunity to show that you want to work with the industry to affect some positive change; please take advantage of this opportunity so as to demonstrate that we need to work together for the benefit of the program and the beneficiaries that we serve as opposed to the “Us” vs “Them” that currently exists in our relationship.

We do not feel that changing that narrative from something provided to the HHA to something that is maintained in the patient file at the referral source is necessarily a reasonable approach to address this issue either.  The small number of crooked doctors and HHAs that want to get around this provision will be able to circumvent this without too much difficulty and it’s going to take reviews and due-diligence in other aspects of what they are doing to catch them in the act; yet the application of this proposed change WILL put 1,000s of law-abiding and compliant HHAs in harm’s way; much like the current application of the F2F provision has.