Certification and Recertification of Terminal Illness and Face-to-Face Encounters
Sets out how terminal illness is certified and recertified: California's initial certification by the Medical Director or Medical Director Designee with a 12-month attestation and an individual narrative written immediately above the physician's signature; the Medicare 6-month certification, timing, sources and narrative rules; face-to-face encounters before the third and later benefit periods; and the safeguards that keep eligibility decisions honest.
About this policy
- Policy number
- CA-HSP-ELC-02
- Version
- 1.0
- Main rule
- 22 CCR §74860(c)
- Library
- California hospice · 60 policies
- Category
- Hospice care
- Sections
- 19
In short
- The Medical Director or Designee certifies terminal illness with the patient's attending physician.
- The physician writes the reasons in their own words, right above their signature. No check boxes or standard wording.
- Give the physician current clinical information in time, but never suggest what to conclude.
- Recertification is due before every new benefit period. Watch the calendar.
- Before the third benefit period and each one after, a hospice physician or nurse practitioner must see the patient face to face within the 30 days before.
What's inside
19 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (22 CCR §74860(c))
- 5. Before Certifying
- 6. The Initial Certification (California and Medicare)
- 7. Timing (If the Agency Is Medicare-Certified)
- 8. Recertification
- 9. Face-to-Face Encounters (If the Agency Is Medicare-Certified)
- 10. Tracking Due Dates
- 11. Integrity Safeguards
- 12. Responsibilities
- 13. Records and Compliance Monitoring
- 14. Staff Training
- 15. References
- 16. Related Policies and Forms
- 17. Approval
- 18. Revision History
An inspector may ask
- Show me the initial certification for this patient. Who signed it, and where is the narrative?
- How do you make sure the narrative is written by the physician and is not standard language?
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