Home Health Eligibility
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Home Health Certification Statement

What is a home health certification statement? It is an attestation that the Medicare beneficiary is eligible for home health services. It is a CMS requirement and condition of payment for a home health agency claim. This attestation can only be completed by one physician or allowed practitioner (NP, PA, CNS as identified in Section 30.2.1 of the Medicare Benefit Policy Manual, Chapter 7. The certifying physician or allowed practitioner must attest that all five eligibility criteria for home health certification have been met:

  • The patient is homebound
  • The patient is in need of skilled services
  • A plan of care has been established and will be periodically reviewed by a physician/allowed practitioner
  • The patient is under the care of a physician/allowed practitioner
  • A face-to-face encounter occurred by a physician/allowed practitioner for the primary reason the patient is in need of home health services

Example Certification Statement: Community Provider is the Referring/ Certifying Provider and will be Monitoring the Home Health Services

  • I certify this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy and/or speech therapy, or continues to need occupational therapy. This patient is under my care, and I have authorized the services on this plan of care and will periodically review the plan. I further certify this patient had a face-to-face encounter that was performed on xx/xx/xxxx by a physician/allowed practitioner that was related to the primary reason the patient requires home health services.

When the beneficiary is referred from an acute or post-acute care facility and the facility provider is certifying eligibility, but will not be monitoring the home health services, the referring/certifying provider must identify the name of the community provider that has agreed to monitor the home health services. That certification statement will read somewhat differently:

Example Certification Statement: (Acute or Post-Acute Care Provider is the Referring/Certifying Provider but is not Monitoring Home Health Services)

  • I certify this patient is confined to his/her home and needs intermittent skilled nursing care, physical therapy and/or speech therapy, or continues to need occupational therapy. I have authorized the services on this initial plan of care which will be further developed by Dr. XXX who has agreed to monitor the home health services. I further certify this patient had a face-to-face encounter that was performed on xx/xx/xxxx by a physician/allowed practitioner that was related to the primary reason the patient requires home health services.

You will note, within both examples above, that the certification statement must include information attesting to the fact that the face-to-face encounter occurred (and when). There is no mandatory form for the certification statement; home health agencies have the discretion to provide the certification in any manner they choose as long as all of the eligibility criteria are included and have been met. The certification statement can appear anywhere in the record, but it is commonly found at the end of the plan of care. As a reminder, certification of home health eligibility criteria should occur when the plan of care is established, or as soon as possible thereafter.

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Revised 8/13/2024