Recertifications for Home Health Services

30.3 - Recertifications for Home Health Services (Rev. 92, Issued: 04-22-15, Effective: 01-01-15, Implementation: 05-11-15) Under both the hospital insurance and supplementary medical insurance programs, when services are continued past an initial 60-day episode of care, the physician must recertify at intervals of at least once every 60 days that there is a continuing need for services in accordance with requirements described in Pub. 100-02, Medicare Benefit Policy Manual, chapter 7, section 30.5.2. The recertification should be obtained at the time the plan of care is reviewed since the same interval (at least once every 60 days) is required for the review of the plan. The physician must include an estimate of how much longer the skilled services will be required and must certify that: 1. The home health services are or were needed because the patient is or was confined to the home as defined in Pub. 100-02, Medicare Benefit Policy Manual, chapter 7, section 30.1; 2. The patient needs or needed skilled nursing services on an intermittent basis (other than solely venipuncture for the purposes of obtaining a blood sample), or physical therapy, or speech-language pathology services; or continues to need occupational therapy after the need for skilled nursing care, physical therapy, or speech-language pathology services ceased. Where a patient’s sole skilled service need is for skilled oversight of unskilled services (management and evaluation of the care plan as defined in Pub. 100-02, Medicare Benefit Policy Manual, chapter 7, section 40.1.2.2), the physician must include a brief narrative describing the clinical justification of this need as part of the recertification, or as a signed addendum to the recertification; 3. A plan of care has been established and is periodically reviewed by a physician; and 4. The services are or were furnished while the patient is or was under the care of a physician. Recertifications must be signed by the physician who reviews the plan of care. The form of the recertification and the manner of obtaining timely recertifications are up to the individual agency.