Medicare Compliance & Reimbursement

• Homebound. The Centers for Medicare & Medicaid Services reiterates its position that being homebound should not be a requirement for the Medicaid home health benefit, particularly in light of the Olmstead Supreme Court decision requiring states to provide services in community settings when possible.

"This is an important difference in the Medicare and Medicaid benefits," stresses Robert Markette Jr. with Benesch/Dann Pecar in Indianapolis. The difference is "crucial" for both admissions decisions and compliance, he says.

"Compliance policies and procedures should reflect that Medicare and Medicaid are not identical and do have some key differences -- homebound is one of them," Markette advises. "This is important, because if you are auditing based upon or complying with the wrong program standards, you can have just as many problems. For example, denying admission to a Medicaid patient because they are not homebound can be a huge problem."

• F2F for DME. The Affordable Care Act law also requires a F2F encounter for durable medical equipment and supplies. CMS proposes a Medicaid requirement similar to that for HHAs.

• Services in the home. Medicaid "home health services cannot ... be restricted to services furnished in the home itself," CMS emphasizes in the rule published in the July 12 Federal Register. Previous letters to Medicaid directors have "set forth specific policy clarifications to allow States more flexibility to serve individuals with disabilities in various ways and in different settings," CMS notes in the rule.