The three steps.
- Document the change. What is different, since when, and what care it now requires — specific, dated, clinical. More help with bathing, a new wound, more frequent nursing needs.
- Your physician certifies it. An updated Letter of Medical Necessity states the new hours per day and days per week, tied to your accepted conditions. What an LMN is →
- The DOL reviews and adjusts. Hours go up when the evidence supports it — and can be reduced when documentation is weak.
“That’s all the hours you get” is not a final answer when your condition has changed. It is a documentation problem wearing a verdict’s clothes.
Why documentation quality decides it.
The DOL authorizes what the record supports. An agency that documents your needs visit by visit can show the change the day it happens; an agency that writes the renewal from memory cannot. At Alara, the request for more hours is drafted from recorded clinical data in our care system — the evidence is already assembled when the need appears. The full guide to how hours are set →
Common questions.
Who do I ask first?
Tell your agency and your physician what has changed, specifically and with dates. The updated certification goes to the DOL from there.
Can hours go down?
Yes — when documentation does not support the current level. That is another reason the record quality matters.
Sources: DEEOIC Procedure Manual, Home & Residential Health Care. The Department of Labor sets and adjusts authorizations.