Or. Admin. Code § 410-122-0090

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-122-0090 - Face-to-Face Encounter Requirements (for Fee-For-Service Clients)

(1) For initial ordering of DME items identified in section (9) of this rule, an in-person or telehealth face-to-face encounter that is related to the primary reason the client requires the medical equipment or supplies must occur no more than six months prior to the start of services.

(2) Telehealth encounters used to satisfy the face-to-face encounter requirement for a DMEPOS item must meet the requirements outlined in the HERC Ancillary Guideline note A5.

(3) The face-to-face encounter shall be conducted and documented by one of the following practitioners:

(a) A physician;

(b) A nurse practitioner or clinical nurse specialist, as authorized by State law;

(c) A physician assistant, as authorized by and in accordance with State law;

(d) A licensed practitioner of the healing arts acting within the scope of practice authorized under State law;

(4) The practitioner responsible for ordering the services must document the face-to-face encounter and clinical findings supporting that the client was evaluated or treated for a condition that supports the need for the DME items ordered within six months prior to completing the written order;

(5) If a dually eligible client is evaluated for medical equipment or supplies under Medicare and transitions to Medicaid, the Medicare face-to-face encounter documentation shall meet the Medicaid face-to-face requirement.

(6) The DME supplier shall maintain and provide documentation of the qualifying face-to-face encounter, written order/prescription, and the supporting documentation when the item requires prior authorization or at the Division's request.

(7) The supporting documentation shall include subjective and objective client-specific information used for diagnosing, treating, and managing a clinical condition for which the DMEPOS is ordered.

(8) The DME supplier shall have documentation on file that supports all coverage criteria in the DMEPOS rules are met.

(9) The table at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Downloads/FINAL-RULE-MASTER-LIST-of-DMEPOS-Subject-to-Frequent-Unnecessary-Utilization-2018-03-30.pdf identifies the DME items subject to these face-to-face requirements.

Or. Admin. Code § 410-122-0090

DMAP 36-2017(Temp), f. 9-14-17, cert. ef. 9-15-17 thru 3-13-18; DMAP 12-2018, adopt filed 03/07/2018, effective 3/8/2018; DMAP 101-2023, amend filed 12/29/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: 414.065