CMS Pub. 100-02, ch. 7, § 30.3

The patient must be under the care of a physician or allowed practitioner who is qualified

to sign the certification and plan of care in accordance with 42 CFR 424.22.

A patient is expected to be under the care of the physician or allowed practitioner who

signs the plan of care. It is expected that in most instances, the physician or allowed

practitioner who certifies the patient’s eligibility for Medicare home health services, in

accordance with §30.5 below, will be the same physician or allowed practitioner who

establishes and signs the plan of care.

30.4 - Needs Skilled Nursing Care on an Intermittent Basis (Other than

Solely Venipuncture for the Purposes of Obtaining a Blood Sample),

Physical Therapy, Speech-Language Pathology Services, or Has

Continued Need for Occupational Therapy

(Rev. 10438, Issued: 11-06-20, Effective: 03-01-20, Implementation: 01- 11-21)

The patient must need one of the following types of services:

1. Skilled nursing care that is

• Reasonable and necessary as defined in §40.1;

• Needed on an "intermittent" basis as defined in §40.1.3; and

• Not solely needed for venipuncture for the purposes of obtaining blood

sample as defined in §40.1.2.13;or

2. Physical therapy as defined in §40.2.2 ; or

3. Speech-language pathology services as defined in §40.2.3; or

4. Have a continuing need for occupational therapy as defined in §§40.2.4 .

The patient has a continued need for occupational therapy when:

1. The services which the patient requires meet the definition of "occupational

therapy" services of §40.2.4, and

2. The patient's eligibility for home health services has been established by virtue of

a prior need for skilled nursing care (other than solely venipuncture for the

purposes of obtaining a blood sample), speech-language pathology services, or

physical therapy in the current or prior certification period.

EXAMPLE: A patient who is recovering from a cerebrovascular accident (CVA) has an

initial plan of care that called for physical therapy, speech-language pathology services,

occupational therapy, and home health aide services. In the next certification period, the

physician or allowed practitioner orders only occupational therapy and home health aide

services because the patient no longer needs the skills of a physical therapist or a speech-language pathologist, but needs the services provided by the occupational therapist. The

patient's need for occupational therapy qualifies him for home health services, including

home health aide services (presuming that all other qualifying criteria are met), because

in the prior certification period the beneficiary’s eligibility for home health services was

established by virtue of prior needs for physical therapy and speech-language pathology,

and occupational therapy was initiated while the patient still required physical therapy

and/or speech language-pathology.