Every finding on record at Simplicity Care, Inc.

Upon patient record review, 5 of 6 applicable records (Patient #2, 4, 6, 8, 9) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patients #2, 4, 6, 8, 9: All records had at a minimum, the initial certification of terminal illness in accordance with the standard(s). However for recertification, there was documented Face to Face visit/findings by the NP and the physician had signed the Face to Face document, but no evidence that the MD or designee completed certification of terminal illness including all requirements for the recertification benefit periods. There was no physician written narrative, no attestation statement and no certification statement of terminal illness/prognosis by the physician, for the identified recertification periods below: Patient #2: Bene Periods 12/21/21-2/18/22: Face to Face Form documentation only. No CTI Patient #4: Bene Periods 9/13/21-11/11/21, 11/12/12-1/10/22, 1/11/22-3/11/22: Face to Face Form documentation only. No CTI Patient #6: Bene Periods 8/23/21-10/21/21, 10/22/21-12/20/21, 12/21/21-2/18/22: Face to Face Form documentation only. No CTI Patient #8: Bene Periods 1/4/22- 3/4/22 Face to Face form documentation only. No CTI Patient #9: 12/1/21-1/29/22 Face to Face form documentation only. No CTI