Help with bathing, dressing, transfers, supervision through the night — the hours a family or an aide already provides. Tax law treats that as qualified medical care when a licensed practitioner certifies the person as chronically ill and prescribes a plan of care. Almost no family has either document. We produce both, once a year, honestly.
This is the statutory definition of a chronically ill individual. It is a real threshold, not a formality — and if a person does not meet it, no certification should exist. We will say so at no cost.
Each of the six activities, asked the way a family actually experiences it: who helps, how often, since when. Then supervision, safety, night-time, wandering, medication. The caregiver answers as proxy and the record says so.
A hospital discharge summary, a neurology or geriatrics note, a therapy evaluation, a dementia diagnosis. The document has to exist — a certification with nothing behind it is exactly the kind that fails later.
A physician licensed where the patient lives reviews the answers and the document and speaks with the family. This is the step that makes the certification a clinical judgement rather than a form.
Two documents: the certification that the person is chronically ill, and the plan of care the services are delivered under. Named physician, NPI, date. Or an honest no, in writing, with the reason.
A PHI-free receipt posts to hashcare.com so the certification can be verified years later without trusting anyone. Eleven months on, we remind you — because the twelve-month clock is the part families miss.
Maintenance and personal care services for a chronically ill individual, under a prescribed plan of care, are qualified medical care — the category HSA and FSA dollars are for.
Around the same plan of care sit services Medicare already pays for — caregiver training, advance care planning, transitional care, care management, and dementia care under the GUIDE Model.
Home care, companion care and care-navigation companies lose sales at exactly this point — the family asks whether they can pay pre-tax and nobody in the room can answer.
Supervision is the whole job, and it is invisible in every record. Severe cognitive impairment with substantial supervision is one of the two doors, on its own.
Transfers, bathing and dressing change overnight, and the 90-day expectation is usually clear from the discharge summary.
Progressive loss of function, documented for years, and often never converted into the two documents that would make the care count.
The care is real, the exhaustion is real, and the household is paying for help out of taxed income when it may not have to.
No single dramatic diagnosis, but two ADLs lost and no one has ever written it down.
Independent with a walker and some forgetfulness is not the standard. Hearing that in two minutes, for nothing, is a service too.
Two activities of daily living, or severe cognitive impairment requiring substantial supervision — that is the line Congress drew, and a certification issued below it puts the family's tax position at risk, not ours. The physician may decline, and the decline is written down and costs the family nothing.
A certification is not a guarantee of reimbursement: your plan administrator applies its own rules, and dependency and deductibility are tax questions for your adviser. Nothing here is legal, tax or medical advice. This pathway is in design; LMN determinations are the live product today, no BAA is executed yet, and pilots run on synthetic data until clinical sign-off and privacy safeguards are complete.