Eligibility, Physician Certification, Face-to-Face Encounter, and DC Medicaid Authorization
Sets out how the Agency confirms, before and during care, that each patient is eligible for the payer’s benefit and that the required certification, face-to-face encounter, orders, and authorizations are in place: Medicare home health eligibility and certification if the Agency is Medicare-certified, DC Medicaid personal care aide orders and PCA Service Authorizations, EPD Waiver service plans, and other payers.
About this policy
- Policy number
- DC-HH-ADM-03
- Version
- 1.0
- Main rule
- 42 CFR §424.22
- Library
- Washington, DC home health · 58 policies
- Category
- Service delivery
- Sections
- 19
In short
- Before care starts, billing and intake check the patient’s coverage and get every order, certification, and authorization the payer needs.
- Medicare (if we are certified): document homebound status and skilled need at the first visit and at the comprehensive assessment.
- DC Medicaid personal care: no service without a current PCA Service Authorization and a written order renewed every 12 months. Never schedule more hours than authorized.
- Tell the supervising nurse at once if a patient may no longer be eligible or an authorization is about to end.
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-B DCMR §3914.2; 42 CFR §424.22; 29 DCMR §5003)
- 5. What Must Be in Place for Each Payer
- 6. Medicare Eligibility (If the Agency Is Medicare-Certified)
- 7. Certification and the Face-to-Face Encounter
- 8. DC Medicaid Personal Care Aide Services
- 9. EPD Waiver Services
- 10. Other Payers
- 11. Tracking Certifications, Orders, and Authorizations
- 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
- For this Medicare patient, show me the certification, the face-to-face encounter documentation, and the date of the encounter.
- How do you confirm homebound status, and when?
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