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Want Medicare To Pay For Home Care? See Your Doctor

Starting next month, seniors getting health care in their homes will have to see a doctor to make sure they actually need the service. Otherwise Medicare won't pay.

Sounds logical, right?

Not so, says a coalition of health providers and consumer groups that complains the rule is overly burdensome on seniors and doctors.

Home health agencies, doctor and consumer groups say frail, homebound seniors won't be able to get to a doctor's office because of their health status or lack of doctors in rural areas.

They also worry that many doctors are either unaware of the new regulation or won't know how to comply with its documentation requirements that call on physicians to certify they or another health care provider, such as a nurse practitioner, have seen a patient for the specific reason of certifying the need for home health care.

"There is a lot of confusion out there, and patients may lose access to their care," said Nora Super, an AARP lobbyist.

Home health agency groups say they understand Medicare's need to reduce unnecessary care but the new rules are too onerous. "We want to make sure beneficiaries who really need the services are not denied it," said Peter Notarstefano, director of home and community based services at Leading Age, which represents nonprofit home health agencies.

The groups are calling for the Centers for Medicare & Medicaid Services to delay implementation of the new requirement until June.

Under the new rule, Medicare beneficiaries will have to see a doctor 90 days before or 30 days after starting home health services in order for the home health agency to get reimbursed.

The new requirement—a provision in the health overhaul law — intends to curb unnecessary Medicare spending and outright fraud. Home health care has been one of the fastest rising costs of the Medicare program, and spending varies dramatically around the country.

Under current law, a doctor must prescribe home health care for patients to receive services, but the physician doesn't have to see a patient to make that determination.

Meanwhile, Medicare advisers to Congress say the regulation doesn't go far enough to reduce waste and fraud because it allows patients to start getting home health services before first seeing a doctor to ensure they need it. "Such a large window ... does not ensure that beneficiaries receive an examination in a timely manner before home health care is delivered," the Medicare Payment Advisory Commission wrote in a report to Congress this month.

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