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July 18, 2019 - Updated 07.22.19

Home Health Recertification Statement

What is the recertification statement? It is an attestation that the Medicare beneficiary is still eligible for home health services. It is a CMS requirement and condition of payment of the home health agency claim. This statement must be signed and dated by the physician who reviews the plan of care and it must indicate the continuing need for skilled services. It can appear anywhere in the record, but it is commonly seen on the plan of care.

CMS mandates that the end of the initial 60-day episode, a decision must be made as to whether or not to recertify the patient for a subsequent 60-day episode:

  1. The home health services are or were needed because the patient is or was confined to the home as defined in §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.
  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.

Example Recertification Statement:

I recertify this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy and/or speech therapy, or continues to need occupational therapy. This patient is under my care, and I have authorized the services on this plan of care, and will periodically review the plan.

Medicare does not limit the number of continuous episode recertifications for beneficiaries who continue to be eligible for the home health benefit.

The policies finalized in the Calendar Year (CY) 2019 Home Health PPS Final Rule (CMS-1689-FC). Specifically, the regulation at 42 CFR 424.22(b)(2) has been revised to remove the requirement that the recertification statement must include an estimate of how much longer the services will be required. This change is effective January 1, 2019.

References:

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