Medicare: New Rule Sparks Complaints from Health Agencies

Medicare is implementing a new rule for its beneficiaries that has sparked complaints from health agencies. The new rule requires beneficiaries to see a doctor 90 days before or 30 days after starting home health services. If they do not comply, home health agencies will not be reimbursed

Home health agencies, hospitals and consumer groups are complaining that the new rule intended to curb unnecessary Medicare spending will make it harder for senior citizens to get home care services. Medicare home health care typically consists of services such as skilled nursing, physical therapy and speech therapy. The services can be prescribed for 60 days at a time, although the number of times they can be renewed is unlimited.

Under the new rule, doctors would have to fill out forms that certify that they or other health care providers such as nurse practitioners had seen patients for the specific purpose of determining the patients' needs for home care. This is in addition to doctors' current duties of prescribing home health care and signing off on care plans, which the home health agencies typically develop.

Under current law, doctors must prescribe home health care for patients to receive services, but the physicians don't have to see the patients to make that determination. Medicare advisers to Congress say the regulation doesn't go far enough to reduce waste and fraud because it allows patients to get home services before first seeing doctors to ensure that they need it.

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