Home Health & Hospice

Physicians Must Certify Need for Management and Evaluation

Homecare Insider, January 25, 2010

There is a new requirement for patients receiving services under management and evaluation of a care plan.  Regulatory language in 42 CFR §424.22, which became effective January 1, 2010, requires physicians to write a brief narrative on the certification or recertification plan of care justifying this service.

It’s likely that physicians will need guidance and education.  The paragraph must provide the physician’s clinical justification for management and evaluation.  This could include information about the patient’s medical diagnoses or problems, limitations in activities of daily living or mental status, and the risk for/history of malnutrition, dehydration, skin breakdown, falls, infections, or other complications that point to inadequate care.  The physician could also note concerns about the caregivers or home situation.

According to the new rules, the physician writes this narrative on the plan of care, it must appear right above the physician’s signature.  If the narrative is on an addendum, the physician must sign both the plan of care and the addendum.

Download the final rule for the Prospective Payment System rate update (that contains this new provision) at — http://edocket.access.gpo.gov/2009/pdf/E9-26503.pdf.

In the December 2009 issue, Homecare DIRECTION discussed this new requirement and provided more guidance for compliance.  To learn more about this monthly newsletter for clinical managers, click here.