OAR 410-127-0045: Face-to-Face Encounter Requirements for Home Health Services

(1) The Division requires that for the initial ordering of home health services, an in-person face-to-face encounter that is related to the primary reason the client requires the home health services must occur within not more than 90 days before or 30 days after the start of services. (2) The face-to-face encounter shall be conducted by: (a) The certifying physician (MD or DO); or (b) An authorized non-physician practitioner (NPP); or (c) An attending or post-acute physician for clients admitted to home health immediately after an acute or post-acute stay. (3) Authorized NPP’s for home health services are nurse practitioners, a clinical nurse specialist working in collaboration with the physician, or a physician associate under the supervision of a physician. (4) If an authorized NPP performs the face-to-face encounter, they shall communicate the clinical findings to the certifying physician. Those clinical findings must be incorporated into a written or electronic document included in the client’s medical record. (5) The certifying physician shall document that the client was evaluated or treated for a condition that supports the need for the home health services ordered within no more than 90 days before or 30 days after the start of services. The certifying physician shall also document the name of the practitioner who conducted the encounter and the date of the encounter. (6) The documentation of the face-to-face encounter must be a separate and distinct section of or an addendum to the certification and must be clearly titled, dated, and signed by the certifying physician. (7) A face-to-face encounter must occur for certification any time a new start of care assessment is completed to initiate care for the home health services. (8) If a dually eligible client begins home health under Medicare and transitions to Medicaid, the Medicare face-to-face encounter documentation shall meet the Medicaid face-to-face requirement. (9) The home health agency shall maintain documentation of the qualifying face-to-face encounter and provide this documentation to the Division with the prior authorization request for services.