Inside the Written Plan of Care for Home Health Care Medicare Patient Certification

Services for patients provided under the Medicare home health benefit must be ordered by a physician and requires certification. Certification must be obtained at the time the plan of treatment (care) is established or as soon thereafter as possible and must be signed by the physician who establishes the plan. 

According to the Centers for Medicare & Medicaid Services (CMS), for a Medicare beneficiary to be eligible to receive home health services, the physician must certify that the patient needs or needed one of these four services: intermittent skilled nursing care; physical therapy; speech-language pathology services; or ongoing occupational therapy, if the patient no longer needs any of the therapies above.  

Eligibility also requires that the patient is or was homebound; the patient services will be or were provided under the care of the certifying physician; and “a face-to-face encounter occurred no more than 90 days prior to or within 30 days after the start of the home health care, and related to the primary reason the patient requires home care.” Documenting the date of encounter is a key element in the plan.  A patient plan must be in place and established by a physician with no financial relationship to the home health agency. The written plan for the patient certification, according to the CMS, must include the following:

  • Evidence that the home heath agency can meet the patient’s medical, nursing, rehabilitative and social needs in his/her home
  • Verification that the patient will receive an individual written plan of care along with any revisions or additions
  • The care and services necessary to meet his/her needs as identified in the comprehensive assessment, including:
    • all relevant diagnoses; 
    • the patient’s mental, psychosocial and cognitive status; 
    • the types of services, supplies and equipment required, the frequency and duration of visits; 
    • prognosis;
    • rehabilitation potential, functional limitations, activities permitted, nutritional requirements; 
    • all medications and treatments and safety measures to prevent injury; 
    • description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors;
    • measurable outcomes that the home health agency anticipates as a result of implementing and coordinating the plan of care; and
    • patient and caregiver education and training to facilitate timely discharge

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