Last month, the Office of Long Term Living (OLTL) issued a bulletin updating its guidelines for use of the Physician Certification form along with an updated form. The Physician Certification form is used when people apply for Home and Community Based Services through the Pennsylvania Independent Enrollment Broker-specifically the Community HealthChoices Waiver, the OBRA Waiver, and the Act 150 program. It is also used when people are applying for the Living Independence for the Elderly (LIFE) Program.
To qualify for these programs, an applicant must meet a certain level of care. The Physician Certification Form, along with an assessment of a person’s needs, is used to determine whether the individual meets the required level of care for each program. Once someone is eligible, they must be reassessed every year to make sure they still meet the required level of care.
Highlights of the bulletin include:
A Physician Certification form is always needed for initial applications for the above programs.
At reassessment, a Physician certification form is only needed if the person is found to no longer meet the required level of care. In these situations, OLTL’s Medical Director will review the case and make a final determination about the level of care.
The form must be signed by a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) who is licensed in Pennsylvania or a state that directly borders Pennsylvania. The one exception is if someone has moved to Pennsylvania from a different state and is making an initial application--a doctor from the state the person is leaving can complete the form.
Forms signed by Physician Assistants (PAs), Certified Registered Nurse Practitioners (CRNPs), or doctors in training will not be accepted.
People who need help getting or keeping Home and Community Based Services are encouraged to call PHLP’s Helpline at 1-800-274-3258.