Medicare program/Home Health Prospective Payment System Rate Update for CY2010:Physician Narrative Requirement, CY2011 Final Physician Face-to-Face Encounte
ICR 201012-0938-009
OMB: 0938-1083
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1083 can be found here:
Medicare program/Home Health
Prospective Payment System Rate Update for CY2010:Physician
Narrative Requirement, CY2011 Final Physician Face-to-Face
Encounte
The Centers for Medicare and Medicaid
Services (CMS) require that a physician sign every patient's
individual plan of care certifying or recertifying that the patient
is homebound and the planned services are medically necessary in
order for the home health agency to be reimbursed for Medicare
covered services as stipulated in 42 CFR 424.22. CMS is relying on
physicians to fulfill a role that is sometimes thought of as a
"gatekeeper" by requiring the physician to provide a narrative
located within the home health certification or recertification
when skilled nursing management & evaluation of the plan of
care, (PoC) is ordered. The physician's narrative is required when
a patient's underlying condition or complication requires a
registered nurse to ensure that essential non-skilled care is
achieving its purpose, The narrative must be located immediately
prior to the physician's signature. If the narrative exists as an
addendum to the certification or recertification form, in addition
to the physician's signature on the certification or
recertification form, the physician must sign immediately following
the narrative in the addendum. This change supports Medicare's home
health coverage criteria for skilled services as stipulated in the
CFR, (see 42 CFR 409.42).The Home Health Prospective Payment System
Rate Update for Calendar Year 2011 changes the certification
requirements for Home Health Agencies. In the case of a
certification made by a physician after January 1, 2010, prior to
making such certification, the physician must document that the
physician himself or herself or specified non-physician
practitioner has had a face-to-face encounter with the patient
incident to the services involved
The Affordable Care Act (PPACA)
of 2010 (Pub. L. 111-148) was enacted. Section 6407 (a) (amended by
section 10605) of the PPACA amends the requirements for physician
certification of home health services contained in Section 1814
(a)(2)(C ) and 1835 (a) (2)(A) by requiring that, "In the case of a
certification made by a physician after January 1, 2010, prior to
making such certification, the physician must document that the
physician himself or herself or specified non-physician
practitioner has had a face-to-face encounter (including through
the use of telehealth, subject to the requirements in section 1834
(m) of the Act)", with the patient incident to the services
involved
$0
No
No
Yes
No
No
Uncollected
Bonnie Harkless
4107865666
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
0938-1083_CMS-10311_Supporting_Statement_final_ 11-03 (2).doc
Home Health CY2011 proposed rule: Face-to-Face encounter, physician's burden for form completion, supporting regulation 424.22 (annual)