CMS To Be Flexible in Enforcing Medicaid Home Health Rule

A deadline for states to comply with a 2016 Medicaid home health final rule is approaching, but the Centers for Medicare & Medicaid Services (CMS) won’t necessarily enforce all compliance areas right away, according to an announcement issued Thursday.

The final rule was published on February 2, 2016, with an effective date of July 1, 2016. The rule included new requirements related to documentation of a face-to-face encounter between a certifying physician and a home health beneficiary. It also expanded the definition of what medical equipment and supplies are covered under the home health benefit.

However, states were generally given up to two years from the effective date to be compliant, based on legislative cycles, due to potential operational and budgetary hurdles that they might face.


“We recognize that there may continue to be state-specific administrative challenges associate with implementing certain provisions of the Medicaid Home Health final rule and that there is confusion surrounding state compliance deadlines,” the announcement reads.

Because changes to the rule requires a rule making process, CMS will not formally extend the deadline but will use its enforcement discretion when it comes to compliance. The agency will use this discretion based on state-specific circumstances, focused on states’ needs.

As such, states will need to identify provisions of the final rule they are unable to implement by the required date based on their legislative timeframes to CMS.


However, CMS will not be flexible on a few measures that codify “longstanding Medicaid home health policy,” including around homebound status.

States must request assistance to CMS by May 31, 2018, for compliance to be assessed and any flexibly can be granted prior to July 1, 2018.

The full announcement can be found here.

Written by Amy Baxter

Companies featured in this article: