In October 2011, the Centers for Medicare & Medicaid Services approved the state’s proposed 10% reduction to Medi-Cal rates for all provider types except three: physician/clinic services for children, home health services, and distinct part subacute facilities. This was a crucial victory for Medi-Cal beneficiaries!

Neil’s Spin: The Medi-Cal Home Health Rates are already sub-standard and less than 1% of licensed home health agencies routinely accept Medi-Cal referrals. A 10% reduction would have been devastating to patients currently using Home Health and it would have created an access to care crisis in California.

Included in the SB411 language, a Home Care Agency would be required to pay an annual licensing fee of $3900 plus $165 for each employee. The $165 would be used to pay for administrative taks associated with the certification of home care aides and for maintaining the online public registry of home care aides employed by each agency. The $165 doesn’t include agency costs for completing 13 hours of initial & ongoing training or the LiveScan background check fees.

Neil’s Spin: This bill counteracts job creation as it leaves employers with a disincentive to hire. The more you hire, the more it costs. That’s counterproductive to the State’s economic goals.   Additionally, Home Care Agencies will experience a dramatic increase in operating costs. To compensate, home care fees will have to increase. Many seniors and disabled individuals are having difficulty affording care at its current prices.

CMS Clarified that if a physician’s visit note, referral documentation, or hospital discharge summary contained all of the required elements, the physician could use that documenation to satisfy the F2F encounter.

CMS also stated they will not accept the use of checkboxes and forms with pre-printed statements that describe homebound status and the need for skilled services.

Neil’s Spin: From experience, we know that the physician’s documentation rarely contains all of the required elements. To no fault of physicians as CMS has not properly educated them on F2F requirements.   So, F2F continues to frustrate physicians and home health providers but enables CMS to deny or delay payment for services.