US · guidance
CMS Pub. 100-04, ch. 30, § 260.4.1.3
Obtain Physician Certification of Risk (Home Health and
CORF services only)
(Rev. 2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13)
A beneficiary must obtain a physician certification stating that failure to continue home
health or CORF services is likely to place the beneficiary’s health at significant risk.
Without such a certification statement a QIO may not make a determination for service
terminations in these settings.
The physician certification is a written statement from any licensed physician contacted
by a beneficiary. This is a special certification required only in this expedited
determination process for expedited determinations in home health and CORF settings.
A beneficiary may request an expedited determination from a QIO before obtaining this
certification of risk. Once the QIO is aware of a review request, it will instruct the
beneficiary on how to obtain the necessary certification from a physician.
History
(Rev. 2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3ba795823d0fc11d0752494f4da07b1e2d18d071d1bb78b7263ed61fcaaad15e
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