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

Sets out how the Agency obtains written certification and recertification of terminal illness for every benefit period, the time limits for oral and written certification, who may certify, what the physician narrative must contain, and how face-to-face encounters before the third and later benefit periods are done, including the limits on telehealth encounters.

Preview: full text with a package
About this policy
Policy number
TX-HSP-ELC-02
Version
1.0
Main rule
42 CFR §418.22
Library
Texas hospice · 59 policies
Category
Hospice care
Sections
23

In short

  • Every benefit period needs a written certification signed and dated by the medical director or physician designee, with the period dates.
  • If the written form is not ready within 2 calendar days after a period starts, get an oral certification by then and write it in the record at once.
  • The physician writes the narrative in their own words about this patient. Never draft it for them.
  • From the third benefit period, a hospice physician or nurse practitioner must see the patient within the 30 days before each recertification.
  • Telehealth visits must be audio and video. Check the three telehealth limits first; if unsure, visit in person.

What's inside

23 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; 26 TAC §558.858)
  • 5. Who Certifies
  • 6. Timing
  • 7. What the Physician Considers
  • 8. Content of Each Certification
  • 9. Oral Certification
  • 10. Face-to-Face Encounters
  • 10.1 Scheduling
  • 10.2 Attestation
  • 10.3 Encounters by telehealth
  • 11. When the Physician Does Not Recertify
  • 12. Texas Medicaid
  • 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 each benefit period for this patient. Was each one signed and dated, with the benefit period dates?
  • Where is the physician’s narrative, and does it reflect this patient’s own clinical circumstances?

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