The home health Conditions of Participation (CoPs) are the federal rules in 42 CFR Part 484 that a home health agency must meet to take part in Medicare. Each Condition needs one or more written policies. The first table below maps each Condition to the policies that meet it, and the second lists the time frames written into the Conditions. Your state's licensing rules add requirements of their own, and Missouri applies the CoPs to every licensed home health agency, certified or not (19 CSR 30-26.010(1)(A)).
Which policies meet each Condition
| Condition | Policies that meet it |
|---|---|
| §484.45 Reporting OASIS information | OASIS data collection, accuracy, transmission and privacy notice |
| §484.50 Patient rights | Patient rights and responsibilities; admission agreement, consent and disclosure of charges; language access; complaints and grievances; transfer and discharge notices; allegations against staff |
| §484.55 Comprehensive assessment of patients | Initial assessment visit and start of care; comprehensive assessment and updates; medication management and drug regimen review |
| §484.58 Discharge planning | Discharge planning, and transfer and discharge summaries |
| §484.60 Care planning, coordination of services and quality of care | Individualized plan of care; coordination of care; physician and allowed practitioner orders, including verbal orders; infusion therapy, where the agency provides it |
| §484.65 Quality assessment and performance improvement | QAPI program; incident reporting, adverse events and investigations |
| §484.70 Infection prevention and control | Infection prevention and control program; employee health screening and immunizations |
| §484.75 Skilled professional services | Skilled nursing; therapy and medical social services |
| §484.80 Home health aide services | Aide qualifications, training and competency; aide assignment, care instructions and supervision |
| §484.100 Compliance with federal, state and local laws | Certification, surveys, ownership disclosure and reporting changes; professional licenses and registries; laboratory services and CLIA |
| §484.102 Emergency preparedness | Emergency preparedness program |
| §484.105 Organization and administration of services | Governing body and lines of authority; administrator and clinical manager; overall plan and budget; policy management and annual review; services under arrangement; referral intake; clinical manager availability and on-call; scope of services |
| §484.110 Clinical records | Clinical record content, authentication and retention; patient access to records; agency closure and continuity of records |
| §484.115 Personnel qualifications | Personnel qualifications, job descriptions, orientation and evaluation; personnel records |
This mapping comes from the Cura Core Michigan home health manual, which follows the federal Conditions alone because Michigan does not license home health agencies. The manuals for other states add policies for their state rules. For what each Condition asks your policies to cover, see what policies are required for home health.
Time frames written into the Conditions
| What | Time frame | Rule |
|---|---|---|
| Notice of patient rights | Before care begins, at the initial evaluation visit; to a representative the patient chooses, within 4 business days | §484.50(a) |
| Initial assessment visit | Within 48 hours of referral or of the patient's return home, or on the ordered start of care date | §484.55(a) |
| Comprehensive assessment | No later than 5 calendar days after the start of care | §484.55(b) |
| Assessment updates | In the last 5 days of every 60 days from the start of care, within 48 hours of return home from a hospital stay of 24 hours or more, and at discharge | §484.55(d) |
| Plan of care review | At least every 60 days | §484.60(c)(1) |
| OASIS transmission | Within 30 days of completing the assessment | §484.45(a) |
| Transfer summary | Within 2 business days of a planned transfer, or of learning of an unplanned one | §484.110(a)(6) |
| Discharge summary | Within 5 business days of discharge | §484.110(a)(6) |
| Aide supervision | At least every 14 days for patients receiving skilled services; every 60 days, on site, for patients receiving aide services only | §484.80(h) |
| Aide in-service training | At least 12 hours in each 12-month period | §484.80(d) |
| Copy of the record for the patient | Free, at the next home visit or within 4 business days, whichever comes first | §484.110(e) |
| Record retention | 5 years after discharge, unless state law sets a longer period | §484.110(c)(1) |
| Emergency preparedness review | At least every 2 years | §484.102 |
Where your state sets a shorter time frame, follow the state's. For example, Louisiana requires the initial visit within 24 hours of referral unless the order says otherwise (LAC 48:I.9123.A.1), and Georgia requires a registered nurse to visit every two weeks for every patient who receives aide services (Rule 111-8-31-.08(d)).
Guides to single Conditions
- What is QAPI in home health? (§484.65)
- What does a home health emergency preparedness plan need to include? (§484.102)
- What should an infection control policy include? (§484.70)
Next step
Every Cura Core home health manual maps its policies to the Conditions of Participation and your state's rules. Pick your state on the home health manuals page and read three of its policies free.