What information must a licensed health care practitioner include in a written certification that a patient is chronically ill for IRS purposes?
Executive summary
A written certification that a patient is a “chronically ill individual” for IRS purposes must state that a licensed health care practitioner has determined the patient meets either the Activities of Daily Living (ADL) trigger or the Cognitive Impairment trigger under IRC §7702B, and must include identifying facts that support which trigger is met, the number and identity of ADLs affected, and the date of certification; insurers and IRS guidance also expect information about duration (90 days or expected lengthy impairment), practitioner licensure, and linkage to a plan of care (as applicable) [1] [2] [3].
1. What the statute requires: the two triggers and the 90‑day baseline
The Internal Revenue Code defines a “chronically ill individual” by two alternative tests: the ADL Trigger — inability to perform without substantial assistance at least two specified ADLs (eating, toileting, transferring, bathing, dressing, continence) for a period of at least 90 days due to loss of functional capacity — and the Cognitive Impairment Trigger — needing substantial supervision due to severe cognitive impairment; a licensed health care practitioner must certify that one of these tests is met (IRC §7702B language summarized) [1] [4].
2. Who must sign and where they must be licensed
The certification must be signed by a licensed health care practitioner; IRS instructions and related guidance require that the certifying practitioner be licensed in the state where the insured lives (or meet alternate standards where state licensing is not required), and insurers often specify acceptable categories of certifiers (e.g., physician, nurse practitioner) consistent with NAIC and federal guidance [2] [4].
3. Minimum factual content the letter should contain
At minimum, the written certification should identify the patient, the certifying practitioner and their license information, the specific trigger being used (ADLs or cognitive impairment), which ADLs the patient cannot perform without substantial assistance (naming the ADLs), a statement that the inability is due to loss of functional capacity and has persisted or is expected to persist at least 90 days (or that substantial supervision is required due to cognitive impairment), and the date of certification — information the IRS requests on Form 1099‑LTC and Form 8853 (latest date certified is explicitly entered on Form 1099‑LTC) [2] [3] [1].
4. Plan of care and supporting documentation: insurer and IRS expectations
Qualified long‑term care services are generally those provided pursuant to a plan of care prescribed by a licensed health care practitioner, and IRS guidance and state rules expect the certification to tie to such a plan or medical documentation; while the statute focuses on the practitioner’s certification, insurers and tax filing instructions treat a documented plan of care, physician notes, and contemporaneous records as essential supporting evidence [5] [2] [6].
5. Timing, recertification and administrative caveats
The certification must be current: IRS rules and Form 8853 guidance require that an individual be certified within the past 12 months for many tax treatments (annual recertification or a recent certification is therefore important), and the Tax Notes interim guidance stresses that the statutory 90‑day requirement and certification by a licensed practitioner are non‑waivable statutory elements even where safe harbors exist [3] [4].
6. Where practice and paperwork diverge — insurers, NAIC standards, and real‑world templates
Practical differences appear: insurers and viatical/settlement providers may require additional attestation consistent with NAIC model acts and viatical settlement standards, and sample certification templates used by CPAs or advisors often add a care‑plan summary and clinical detail beyond the statutory minimum; taxpayers and practitioners should be aware that meeting insurer or settlement standards can require more documentation than the narrow IRC language [2] [7] [8].
7. Bottom line
A defensible IRS‑grade certification is a signed, dated statement from a licensed health care practitioner that names the patient, declares which statutory trigger (ADLs or cognitive impairment) is met, specifies which ADLs and that at least two are impaired for ≥90 days (or documents the need for continual supervision because of cognitive impairment), references the plan of care or medical records, and includes the practitioner’s licensure information and the certification date; additional documentation and annual recertification are commonly required by insurers and for favorable tax treatment [1] [2] [3] [5].