Agencies delivering personal care to MO HealthNet children under 21 send this certification to the child's physician before they can request prior authorization from the Bureau of Special Health Care Needs. The agency fills in a care plan describing the amount, duration and scope of services, and the physician certifies that those services are medically necessary for a patient under their care.
The agency enters its details, the physician's, the child's name, Medicaid number, birthdate and diagnosis, and the care plan, and an agency representative signs. The physician signs and dates the certification.
Download the current version from the source each time; forms change without notice.
Physician Certification of Need for Personal Care Services
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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No. MO HealthNet says the Physician Certification of Need for Personal Care Services is not a standard form: a provider may create its own, as long as it contains sufficient information, or make copies of the sample MO HealthNet posts on its forms page.
A child under 21 enrolled in MO HealthNet who has been referred to an agency for personal care services. The physician's approval is needed before the agency can request prior authorization from the Bureau of Special Health Care Needs for the services in the care plan.
At least every six months. The certification statement reads that the patient is under the physician's care, that the services in the care plan are medically necessary, and that the physician will review the need for personal care at least every six months.