Starting Jan. 1, you have 5 percent less on average to work with. Home health agencies have a slew of new requirements to comply with in a few shorts days, and less resources to do so. Agencies will have to tackle new requirements for face to face encounters, new billing codes, physician signature dating, and more with almost 5 percent less Medicare reimbursement, on average. The prospective payment system final rule for 2011, published in the Nov. 17 Federal Register, slashed agencies' Medicare rates by that amount (see Eli's HCW, Vol. XIX, No. 39, p. 306). The cuts could close some providers' doors and will certainly impact care given to patients. "In Connecticut alone, you're looking at in excess of $18 million in lost revenue," Bill Sullivan, CEO of the Visiting Nurse Services of Connecticut, recently told the Connecticut Mirror newspaper. "The potential consequence ... is denial of patient access." The face to face encounter requirement will be particularly burdensome under agencies' reduced resources. "It's a logistical nightmare," the Connecticut Association for Home Care & Hospice's Kim Skehan told the Mirror.