Physician Certification chronically ill patient language for IRS
Executive summary
A physician’s certification that a patient is “chronically ill” for IRS purposes must state that a licensed health care practitioner has certified—within the required timeframe—that the individual meets the statutory test (unable to perform at least two Activities of Daily Living (ADLs) for at least 90 days, or requires substantial supervision due to severe cognitive impairment) and must include the date, practitioner identification, and an accompanying plan of care when relevant; these elements derive from section 7702B and IRS instructions for LTC/accelerated death benefit reporting [1] [2] [3]. The practical result: a concise, dated physician statement that maps the patient’s functional deficits to the statutory language and identifies the certifying professional role is what the IRS looks for [4] [5].
1. What the law requires: the statutory test translated into certification language
The statute defines a “chronically ill individual” as someone certified by a licensed health care practitioner as being unable to perform (without substantial assistance) at least two ADLs for a period of at least 90 days, having a comparable level of disability, or requiring substantial supervision to protect health and safety because of severe cognitive impairment; a certification therefore must reference one or more of these statutory prongs in clear terms [1] [2]. The IRS and related forms reiterate those criteria and expect the certification to identify which prong applies—ADLs, comparable disability, or severe cognitive impairment—and to include the latest date certified [3] [4].
2. Who can sign and how often it must be made or refreshed
“Licensed health care practitioner” for these purposes includes physicians (as defined under Social Security Act §1861(r)), registered nurses, licensed social workers, and others meeting Treasury requirements; however, many long‑term care and IRS guidance treat a physician’s certification as the primary document for tax treatment and exclusion purposes [2] [6]. IRS guidance further requires that chronic‑ill status be certified at least annually for some programs and reporting (for example, reporting and exclusion rules discussed in Form 8853 guidance), so the certification should include the date and be refreshed per insurer/IRS timing expectations [4].
3. Essential elements and exact phrasing to include in a physician’s certification
A compliant certification should: identify the patient by name, state that the patient “meets the IRS definition of a chronically ill individual under Section 7702B” or explicitly cite the statutory criteria, specify which criterion is met (e.g., “unable to perform without substantial assistance at least two ADLs—bathing and dressing—for a period of at least 90 days”), provide the approximate or exact date the condition began or the latest date certified, note if severe cognitive impairment and the evidence for substantial supervision is present, identify the certifying practitioner’s professional designation and license, and include the practitioner’s signature, printed name, address, and date [1] [2] [5]. Templates used by insurers and tax practitioners reflect these elements and often include checkboxes for ADLs and cognitive impairment to align clinical observations with tax language [5] [7].
4. Practical sample language clinicians and families can adapt
A clear, IRS‑aligned sentence set could read: “I certify that [Patient Name] is a chronically ill individual as defined in 26 U.S.C. §7702B and IRS guidance because, beginning on [date], the patient has been unable to perform without substantial assistance at least two activities of daily living (specifically: [list ADLs]) for a period expected to be at least 90 days. Alternatively, if applicable: ‘The patient requires substantial supervision to protect health or safety due to severe cognitive impairment (clinical evidence: [brief note]).’ Certifier: [Name], [Professional Title], License #, Signature, Date.” This mirrors statutory language and is consistent with IRS/insurance templates [1] [3] [5].
5. Pitfalls, alternative views, and practical advice
Tax reviewers and insurers may scrutinize back‑dating or vague statements; contemporaneous clinical notes and a formal plan of care prescribed by a licensed practitioner strengthen the certification’s credibility [6] [8]. There are differing emphases: insurers often want plan‑of‑care language tied to long‑term‑care contract payments, while the IRS focuses on the statutory functional criteria for exclusions and deductions, so certifications should serve both audiences by using statutory phrasing and attaching clinical documentation or a plan of care when possible [6] [4]. Reporting forms—Form 1099‑LTC and instructions and Form 8853 guidance—connect the certification to reporting and exclusion rules, so preserving the signed certification and dated clinical evidence is essential for later audits or claims [3] [4].