CMS Offers States Flexibility In Enforcing Medicaid Home Health Final Rule

Posted on Tuesday, April 10, 2018 8:44 PM

The Centers for Medicare & Medicaid Services (CMS) has issued a letter to State Governors announcing its intensions to work with states to apply certain provisions of the Medicaid Home Health final rule and help eliminate confusion surrounding compliance deadlines.

“CMS has received feedback from states regarding the continued administrative challenges associated with implementing several of the provisions of the rule. Recognizing that the regulations cannot be altered without going through the rulemaking process, CMS intends to use their enforcement discretion in working with states unable to meet compliance deadlines, for example, when complying with the Medicaid face to face requirements. This enforcement discretion will be based on state-specific facts and circumstances and focus on states’ specific needs.”

States should follow their normal procedure to identify the specific provisions of the final rule they are unable to implement by the deadline date. 

“However, CMS will not permit flexibility for the following provisions in the rule which codify longstanding Medicaid home health policy.

  1. The prohibition on requiring that the availability of all home health service is contingent upon the individual needing nursing or therapy services found in § 440.70(b);
  1. The requirements found at § 440.70(b)(3)(v) codifying CMS long standing policy implementing the ruling of the United States Court of Appeals for the Second Circuit in DeSario v. Thomas , 139 F. 3d 80 (1998). Specifically, a state may develop a list of pre-approved items of medical equipment as an administrative convenience, but must provide individuals with a reasonable and meaningful procedure for requesting items that do not appear on such a list; and
  1. The homebound prohibition on Medicaid home health services and settings in which individuals can receive Medicaid home health services found in §440.70(c)(1).”

Source: NAHC Report

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