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Certification and Recertification of Terminal Illness and Face-to-Face Encounters

Sets out how the Agency obtains certification and recertification that each patient is terminally ill: who certifies for the initial and later benefit periods, the two-day and 15-day timing rules, the content of the certification and the physician's own narrative, the face-to-face encounter before the third and each later benefit period (including the telehealth rules through December 31, 2027), oral certification, the MO HealthNet certification rule, and what happens when a physician will not recertify.

Preview: full text with a package
About this policy
Policy number
MO-HSP-ELC-02
Version
1.0
Main rule
42 CFR §418.22
Library
Missouri hospice · 59 policies
Category
Hospice care
Sections
21

In short

  • Every benefit period needs a written certification that the patient has six months or less to live if the illness runs its normal course.
  • If the written certification cannot be signed within two calendar days after the period starts, get an oral certification within those two days and write it in the record at once.
  • Certifications may be signed no more than 15 calendar days before the period starts. Ask early so they are signed on time.
  • Only the physician writes the narrative. Never draft or pre-fill it.
  • From the third benefit period on, a hospice physician or nurse practitioner must see the patient within 30 days before each new period, and sign an attestation.

What's inside

21 sections. The full text comes with the One-time Policy Pack.

Full text with a package
  • Terms of Reference
  • 1. Purpose
  • 2. Scope
  • 3. Definitions
  • 4. Policy Statement (42 CFR §418.22; 13 CSR 70-50.010(3)(A))
  • 5. Who Certifies
  • 6. Timing
  • 7. Content of the Certification
  • 8. The Physician's Narrative
  • 9. Face-to-Face Encounters
  • 9.1 Face-to-face encounters by telehealth
  • 10. Oral Certification and Filing
  • 11. Tracking
  • 12. When a Physician Does Not Certify or Recertify
  • 13. Responsibilities
  • 14. Records and Compliance Monitoring
  • 15. Staff Training
  • 16. References
  • 17. Related Policies and Forms
  • 18. Approval
  • 19. Revision History

An inspector may ask

  • Show me the certification for this benefit period. When was it signed, and when did the period begin?
  • Where is the physician's narrative, and does it describe this patient's own clinical findings?

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