Starting this week, seniors will need to visit a physician before or after beginning a home health aide program — instead of getting a prescription over the phone – if they want Medicare to pay for the visits

The change is part of last year's healthcare overhaul and is designed to improve care and reduce fraud. But many groups say the required trips to the doctor's office will add an extra bureaucratic step and impose a burden on the elderly.

Nora Super, from the AARP, said Medicare should delay the rule because people are confused about what it entails.

"There's a lot of confusion out in the field about what home health agencies, physicians and nurse practitioners and those who have to comply with the rule have to do exactly," Super said. "Before it goes into effect, we want to make sure all the providers are clear about what they need to do and all the patients are clear about what they need to do to make sure no patients are denied access to care they really need."

Many advocates for the elderly — and for the people who service them — say the new requirement adds increases the burden for people who are home-bound and adds an extra layer of bureaucracy and paperwork.

Supporters say mandatory in-person doctors' visits will improve care and reduce fraud.

Under the new rule, patients must visit a doctor up to 90 days before or 30 days after home health aides begin working.

By law, prescriptions for home health aides must be renewed every 60 days, but there's no limit to how many times the prescriptions can be renewed.

In New York, about 174,000 people in New York received Medicare for home health visits in 2009. Between 2002 and 2009, Medicare spending on home health programs doubled nationwide to $19 billion.  

The rule was originally scheduled to take effect on January 1, but was postponed to April 1.