CMS Pub. 100-02, ch. 7, § 30.5.1.1

1. Allowed Provider Types

As part of the certification of patient eligibility for the Medicare home health benefit, a

face-to-face encounter with the patient must be performed by the certifying physician or

allowed practitioner himself or herself, a physician or allowed practitioner that cared for

the patient in the acute or post-acute care facility (with privileges who cared for the

patient in an acute or post-acute care facility from which the patient was directly admitted

to home health) or an allowed non-physician practitioner (NPP).

NPPs who are allowed to perform the encounter are:

• A nurse practitioner or a clinical nurse specialist working in accordance with State

law and in collaboration with the certifying physician or in collaboration with an

acute or post-acute care physician, with privileges, who cared for the patient in

the acute or post-acute care facility from which the patient was directly admitted

to home health;

• A certified nurse midwife, as authorized by State law, under the supervision of the

certifying physician or under the supervision of an acute or post-acute care

physician with privileges who cared for the patient in the acute or post-acute care

facility from which the patient was directly admitted to home health;

• A physician assistant under the supervision of the certifying physician or under

the supervision of an acute or post-acute care physician with privileges who cared

for the patient in the acute or post-acute care facility from which the patient was

directly admitted to home health.

NPPs performing the encounter are subject to the same financial restrictions with the

HHA as the certifying physician, as described in 42 CFR 424.22(d).

2. Timeframe Requirements

• The encounter must occur no more than 90 days prior to the home health start of

care date or within 30 days after the start of care.

• In situations when a physician or allowed practitioner orders home health care for

the patient based on a new condition that was not evident during a visit within the

90 days prior to start of care, the physician or an allowed NPP must see the

patient again within 30 days after admission. Specifically, if a patient saw the

physician or NPP within the 90 days prior to start of care, another encounter

would be needed if the patient’s condition had changed to the extent that

standards of practice would indicate that the physician or a non-physician

practitioner should examine the patient in order to establish an effective treatment

plan.

3. Exceptional Circumstances

When a home health patient dies shortly after admission, before the face-to-face

encounter occurs, if the contractor determines a good faith effort existed on the part of the

HHA to facilitate/coordinate the encounter and if all other certification requirements are

met, the certification is deemed to be complete.

4. Telehealth

The face-to-face encounter can be performed via a telehealth service, in an approved

originating site. An originating site is considered to be the location of an eligible

Medicare beneficiary at the time the service being furnished via a telecommunications

system occurs. Medicare beneficiaries are eligible for telehealth services only if they are

presented from an originating site located in a rural health professional shortage area or in

a county outside of a Metropolitan Statistical Area.

Entities that participate in a Federal telemedicine demonstration project approved by (or

receiving funding from) the Secretary of the Department of Health and Human Services

as of December 31, 2000, qualify as originating sites regardless of geographic location.

The originating sites authorized by law are:

• The office of a physician or practitioner;

• Hospitals;

• Critical Access Hospitals (CAH);

• Rural Health Clinics (RHC);

• Federally Qualified Health Centers (FQHC);

• Hospital-based or CAH-based Renal Dialysis Centers (including satellites);

• Skilled Nursing Facilities (SNF); and

• Community Mental Health Centers (CMHC).