DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
Center for Medicaid , CHIP and Survey & Certification 
 
CMCS Informational Bulletin  
 
DATE:    September 8, 2010 
 
FROM:   Cindy Mann, Director  
               Center for Medicaid, CHIP and Survey & Certification (CMCS)  
 
SUBJECT:   Opportunity to Comment on Proposed Rule to Implement Section 6407 of 
the Affordable Care Act:  Home Health  
 
I am writing to remind you that on Friday, July 23, 2010, the Centers for Medicare & Medicaid 
Services published in the Federal Register the Proposed Rule to incorporate new legislative 
requirements in the Affordable Care Act which mandate that, prior to certifying a patients 
eligibility for the Medicare home health benefit, the physician must document that the physician 
or a non-physician practitioner has had a face-to-face encounter with the patient.  Section 6407 is 
largely a Medicare provision but it applies to Medicaid in the same manner and to the same 
extent in the case of physicians authorizing home health services. 
 
Section 6407 (as amended by Section 10605) of the Affordable Care Act requires that physicians 
document the existence of a face-to-face encounter (including through the use of telehealth) with 
the Medicaid eligible individual prior to ordering the provision of home health services.  This 
face-to-face encounter may be conducted by the physician, by a nurse practitioner or clinical 
nurse specialist working in collaboration with the physician in accordance with State law, by a 
certified nurse-midwife as authorized by State law, or by a physician assistant under the 
supervision of the physician.  In addition, the Affordable Care Act requires that the physician 
document the existence of a face-to-face encounter (including through the use of telehealth) with 
the Medicaid eligible individual prior to ordering medical supplies, equipment or appliances.  
This face-to-face encounter may also be conducted by any of the individuals referenced above, 
with the exception of certified nurse-midwives.  The proposed rule establishes timeframes for 
these encounters and documentation requirements associated with the provision. 
 
The Medicare program included this Proposed Rule in the Home Health Prospective Payment 
System Rate Update for Calendar Year 2011.  The proposed effective date for implementing the 
face-to-face encounters as they relate to home health is January 1, 2011.  The Medicaid program 
is currently promulgating a Notice of Proposed Rulemaking (NPRM) to implement this 
Affordable Care Act provision in 42 CFR 440.70.  While a Medicaid-specific NPRM will be 
published at a later date, we wanted to make States aware of the opportunity to comment on the 
Medicare proposed rule as these comments will inform the promulgation of final rules in both 
the Medicare and Medicaid programs.  
     
 
 
Page 2 - CMCS Informational Bulletin 
 
Comments on the Medicare proposed rule are due no later than 5 p.m. on September 14, 2010. 
 
The regulation is available for viewing at:   
http://edocket.access.gpo.gov/2010/pdf/2010-17753.pdf 
 
Thank you for your continued commitment to these critical health coverage programs.  Questions 
regarding this rule can be directed to Linda Peltz, Director, Division of Coverage and 
Integration, Disabled and Elderly Health Programs Group, at 410-786-3399, or via email at 
linda.peltz@cms.hhs.gov.