N.C. Medicaid Clinical Coverage Policy No. 3D, Attachment B(A)

The Affordable Care Act, Section 3132 outlines specific timeframes for the face-to-face contact to

occur. Failure to meet the face-to-face encounter requirements and time frames results in a failure

by the hospice to meet the beneficiary’s recertification of terminal illness eligibility requirement

and the beneficiary would cease to be eligible for the hospice benefit.

1. Timeframe of the Encounter

a. The encounter must occur no more than 30 calendar days prior to the start of the third

election period, and no more than 30 calendar days prior to every subsequent election

period thereafter.

b. The encounter must be rendered by the hospice physician or Medicare-officially

recognized provider.

2. Timeframe Exceptions

a. Exceptions to timeframe guidelines are permitted for admission of a new hospice

beneficiary in the third or later election period. Exceptional circumstances may prevent a

face-to-face encounter prior to the start of the election period in cases where a hospice

newly admits a Medicaid beneficiary who is in the third or later election period. The face-to-face encounter must occur no later than seven calendar days after the admission for

these beneficiaries. The exceptional circumstance that prevented the face-to face encounter

from being conducted in a timely manner must be documented in the beneficiary’s health

record.

b. Exceptions to the timeframe are permitted when the hospice may be unaware that the

patient is in the third election period. In such documented cases, a face-to-face encounter

which occurs within seven days after admission will be considered timely. The hospice

agency shall document the circumstances for the exception.