A home health agency needs written policies for everything the federal Conditions of Participation (42 CFR Part 484) and its state's licensing rules regulate: patient rights and complaints, assessment, care planning and orders, discharge and transfer, quality improvement (QAPI), infection control, emergency preparedness, skilled services, home health aide training and supervision, governance, clinical records and personnel qualifications. A Medicare-certified agency must meet the federal rules. Most states also license home health agencies and add rules of their own, so the manual has to follow both.
What the federal Conditions of Participation require
| Section | What your policies set out |
|---|---|
| §484.45 Reporting OASIS information | Encoding and sending OASIS assessment data to CMS |
| §484.50 Patient rights | The written notice of rights given at the start of care, how patients complain, and how the agency investigates complaints |
| §484.55 Comprehensive assessment | An initial assessment visit within 48 hours of referral or of the patient's return home (or on the ordered start of care date), and a comprehensive assessment no later than 5 calendar days after the start of care |
| §484.58 Discharge planning | Planning for discharge and transfer, and the information sent to the next provider |
| §484.60 Care planning and coordination | The individualized plan of care, orders from the physician or allowed practitioner, and coordination of services |
| §484.65 QAPI | A quality assessment and performance improvement program driven by data, with improvement projects and tracking of adverse events |
| §484.70 Infection prevention and control | Standard precautions, an infection control program, and education for staff, patients and caregivers |
| §484.75 Skilled professional services | What nurses, therapists and social workers do, and how they are supervised |
| §484.80 Home health aide services | Aide training, competency evaluation, assignments and supervision |
| §484.102 Emergency preparedness | A risk assessment, the emergency plan, a communication plan, training and testing |
| §484.105 Organization and administration | The governing body, the administrator, the clinical manager, and services provided under arrangement |
| §484.110 Clinical records | What each record contains, how entries are signed, how long records are kept and how they are protected |
| §484.115 Personnel qualifications | The qualifications for each role |
Who licenses home health in each state
Each state names its own license and rules. Michigan does not license home health agencies: a Michigan agency's standing rests on its Medicare certification. In North Carolina a home health agency holds a home care license under 10A NCAC 13J and also needs a certificate of need.
| State | License | Rules | Policies |
|---|---|---|---|
| Texas | HCSSA license, Licensed Home Health Services (LHHS or LCHHS) | 26 TAC Chapter 558 and 42 CFR 484 | 56 |
| Pennsylvania | Pennsylvania home health care agency license | 28 Pa. Code Chapter 601 and 42 CFR 484 | 56 |
| Georgia | Georgia home health agency license | Rules 111-8-31 and 42 CFR 484 | 56 |
| Florida | Florida home health agency license (skilled care) | Rule 59A-8 and 42 CFR 484 | 57 |
| California | California home health agency license | Title 22 CCR and 42 CFR 484 | 58 |
| North Carolina | North Carolina home care agency license (Medicare-certified home health agency) | 10A NCAC 13J and 42 CFR 484 | 57 |
| Ohio | Ohio skilled home health services license | OAC 3701-60 and 42 CFR 484 | 59 |
| Louisiana | Louisiana home health agency license | LAC 48:I Chapter 91 and 42 CFR 484 | 57 |
| Missouri | Missouri home health agency license | 19 CSR 30-26 and 42 CFR 484 | 57 |
| Michigan | Medicare-certified home health agency (no Michigan license) | 42 CFR 484 | 57 |
| Washington, DC | District of Columbia home care agency license (home health) | 22-B DCMR Chapter 39 and 42 CFR 484 | 58 |
Where state rules go further than Medicare
Many states add requirements on top of the federal rules. A few examples from the manuals:
- Louisiana: a registered nurse or the appropriate therapist makes the initial visit within 24 hours of referral, unless the order says otherwise, where the federal rule allows 48 hours (LAC 48:I.9123.A.1). See the Louisiana home health manual.
- Georgia: a registered nurse visits the residence at least every two weeks for every patient who receives aide services (Rule 111-8-31-.08(d)), and a new agency needs a certificate of need (Rule 111-2-2-.32(1)). See the Georgia home health manual.
- Missouri: every licensed agency must meet the Medicare Conditions of Participation, adds dementia-specific training at orientation and every year, and has the plan of treatment reviewed by a physician at least once every six months (19 CSR 30-26.010). See the Missouri home health manual.
- Florida: on the first day of service, each patient is told how to complain to AHCA, how to report abuse and how to report Medicaid fraud (s. 408.810(5), F.S.). See the Florida home health manual.
- Pennsylvania: a review at least every quarter of a sample of active and closed clinical records (28 Pa. Code §601.22(d)). See the Pennsylvania home health manual.
Certified, or licensed only
If your agency is Medicare-certified, its policies must meet both the federal Conditions of Participation and your state's rules. If it is licensed but not certified, your state's rules apply, and some states make the federal standards part of state law, as Missouri does. Where a state's rules are silent on a subject, as Ohio's are on patient rights, infection control and aide training, Cura Core's manual follows the federal Conditions of Participation.
A policy only counts if your staff follow it
Surveyors ask nurses and aides how they follow your policies, not only whether the manual exists. Have each staff member read and sign the policies for their job, and keep the dated record. See how staff sign-off works.
Next step
Pick your state in the table above to see its home health manual and read three of its policies free, or see all home health manuals.