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Change to Obtaining Signed Physician Orders for Home Care

The Department of Health (DOH) has finalized the regulation for allowing agencies to obtain signed physician orders for home care providers from the previous 30 day timeframe to within 12 months.

The final rule was posted in the May 4th, NYS Register on page 36 and DOH has posted a Dear Administrator Letter (DAL) on HCS. DOH had asked for comments on the proposed rule allowing for written physician orders for home care to be obtained within one year. LeadingAge New York was one of three entities that submitted comments supporting this change.  

As we have previously reported allowing for this flexibility was a result of numerous discussions during the Home and Community-based Care workgroup meetings. During the two years that the workgroup met, LeadingAge NY and other home care associations expressed support for this change. This change applies to Certified Home Health Agencies (CHHAs), Licensed Home Care Service Agencies (LHCSAs), and Long Term Home Health Care Programs (LTHHCPs).

Please read the DAL carefully, especially the second paragraph,

the timeframe for agencies to obtain signed physician orders (written authorization) based on verbal orders is extended to provide consistency with payment rules for Medicaid and Medicare, and alleviate the adverse impact related to the provider’s ability to bill and receive payment for services delivered based on verbal orders.”

Prior to this rule change, home care providers had to obtain signed physician orders within 30 days of the start of home care. The state regulations require a provider to obtain these orders prior to billing, and the state’s billing system itself does not allow for claims to be submitted after 90 days of the service date. This created an extreme hardship for our home care providers “chasing” down signed physician orders. Many members experienced significant financial losses as a result on not being able to bill after 90-days even if the physician written order was acquired late.

As stated in the DAL, the only change that has resulted from this new rule is the timeframe to obtain written orders based on verbal orders, all other requirements are the same.    

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871