Physician Order Documentation Process for Licensed Home Care Service Agencies

What are Physician Orders?

Physician Orders establish the need for home care services and identify the level of care required for eligible members. They are different from prior authorization requests and are regulated by New York State guidelines.

LHCSAs are responsible for obtaining physician’s orders, including the patient’s provider signature, and submitting them to the New York State Independent Assessor Program (NYIAP). The Physician's Order for Personal Care/Consumer Directed Personal Assistance Services form can be found on NYDOH’s site (here).

Once the need and level of care has been established, LHCSAs are expected to collaborate with Healthfirst to create an appropriate Plan of Care and obtain prior authorization for services to the member.

How should LHCSAs document Physician Orders with Healthfirst?

Healthfirst requires LHCSAs to document physician orders at the initiation of home care services and at least annually thereafter. Physician orders should be reviewed and updated as necessary to meet the member’s changing needs.

Providers may submit physician orders using the Support Documentation function as part of the Online Authorization tool. Alternatively, providers may fax the order via 1-646-313-4603.

What are the responsibilities of a LHCSA?

1. Notify Healthfirst: LHCSAs must notify Healthfirst if a member:

• Refuses nursing shift(s) as part of the LHCSA Private Duty Nursing benefit
• Experiences an adverse event, unsafe situation, incidents (i.e. falls), or sentinel events
• Is being discharged from Home Care, a Hospital, or from a Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), or Long Term Acute Care Hospital (LTACH)
• Misses three (3) consecutive visits within a 14-day period

2. Member Assessment: LHCSAs should verify that the member is enrolled in a plan eligible for home healthcare services and subsequently assess the member’s physical, psychological, and social needs to determine the appropriateness of setting for services.

3. Establishing a Treatment Plan: After verifying member eligibility and appropriateness, LHCSAs are required to assess a member’s physical, psychological, and social needs to develop a treatment plan that has been approved by the referring provider.

4. Submit Required Documentation New York Independent Assessor Program: The New York Independent Assessor Program (NYIAP) assesses individuals seeking Community Based Long Term Services and Supports (CBLTSS). The assessment process is outlined on the New York Independent Assessor Program (NYIAP) website.

5. Submit Physician Order Documentation to Healthfirst: LHCSAs should submit NYIAP approved Physician Orders to Healthfirst at the initiation of PCS, and annually thereafter, through Healthfirst’s provider portal using the support documentation function.

6. Request Prior Authorization for Services: LHCSAs are responsible for obtaining authorization from Healthfirst before providing services when:

• A member is starting a new treatment plan
• Changes need to be made to the treatment plan (i.e. if a member improves or if a member needs more services)
• A member requires extended duration of home healthcare services
• A member requires Private Duty Nursing or PCS

Additional Resources

• Physicians Order for Personal Care/Consumer Directed Personal Assistance Services Form
• New York Independent Assessor Program (NYIAP) website
• Healthfirst Provider Manual

Questions

If you have any questions, please contact your Network Account Manager or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).

Released January 2025