The Department of Vermont Health Access (DVHA) will soon release a directive to implement the "face-to-face" requirement in the Medicaid program. Until relatively recently, Vermont was exempt from this federal requirement, which requires physicians to see patients in person before ordering home health services. Changes to Vermont's program recently eliminated that exemption. The implementation of Medicare face-to-face has challenged agencies across the country. While home health agencies support the concept of physicians visiting with patients prior to ordering home health services, the documentation requirements and audit process are deeply flawed. We have been working closely with DVHA on this issue and are hopeful the Medicaid implementation will be smoother and less burdensome. We appreciate the spirit of collaboration with which DVHA officials have approached this issue.

The new Home Health Conditions of Participation went into effect on January 13, 2018. These are wide-ranging federal regulations that are required for agencies that care for individuals under the Medicare and Medicaid programs. The rollout has been frustrating for home health agencies. The Centers for Medicare and Medicaid Services (CMS) was slow to release the "Interpretive Guidance" document that clarifies the rule and guides the surveyors who determine whether an agency follows the regulation. In fact, the rule is going into effect with only a draft interpretive guideline in place. In our view, CMS officials have downplayed the significance of the Interpretive Guidance. That said, they did agree to defer the imposition of civil monetary penalties for a year, except in "immediate jeopardy" situations.