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Missouri Home Health Policy and Procedure Manual

For Missouri home health agencies licensed by the Department of Health and Senior Services (DHSS). The manual has 57 policies and 46 forms, written to 19 CSR 30-26.010, the home health licensure rule, and the home health Conditions of Participation (42 CFR Part 484), which Missouri applies to every licensed agency. Each policy opens with a plain-English summary and names the rule it follows, and every one is filled in with your agency's details. You get Word and PDF files to keep, and your staff sign off on their phones.

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Missouri · Home health

57 policies written to the Missouri rules, with 46 forms. Every one is filled in with your agency's details.

  • A plain-English summary first
  • The rule each policy follows
  • Word and PDF downloads, yours to keep
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Policies
57
Forms
46
Categories
13
Policy Pack · required
$950one-timeIncludes 90 days in the portal with Premium. To keep it open after that, Premium is $99 a month or $990 a year.

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3 free sample policies, shown in full for a sample agency.

MO-HH-CMP-01Free sample Client rights

Complaints and Grievances, and the State Home Health Hotline

Sets out how patients, representatives, caregivers and families can complain to the Agency or to the Missouri Department of Health and Senior Services; how the Agency logs, acknowledges, investigates, resolves and documents every complaint within its own time frames (5 to acknowledge and 30 to resolve); how it protects patients from retaliation during and after an investigation; and how complaints alleging abuse, neglect or misappropriation are reported to the Department at once, under 42 CFR §484.50(e) as adopted by 19 CSR 30-26.010(1)(A), 19 CSR 30-26.010(2)(H) and RSMo §197.435.

Read the full policy MO-HH-SG-01Free sample Safeguarding

Abuse, Neglect, and Exploitation of Patients: Mandated Reporting to the Department

Sets out how every staff member recognizes and immediately reports suspected abuse, neglect, financial exploitation, bullying, mistreatment, misappropriation and injuries of unknown source to the Missouri Department of Health and Senior Services, as RSMo §192.2405 requires of home health agencies and their employees and 42 CFR §484.50(e)(2) requires of all home health staff; what the Agency does to protect the patient and cooperate with the Department; the protections for reporters; and the penalty for failing to report.

Read the full policy MO-HH-IC-01Free sample Infection control

Infection Prevention and Control Program

Sets out the Agency's documented infection prevention and control program: standard precautions and accepted standards of practice, bag technique and equipment cleaning, transmission-based precautions and respirator use, agency-wide surveillance, investigation and an action plan built into QAPI, reporting of communicable diseases to the local health authority or the Department within the time frames in 19 CSR 20-20.020, staff health and work restrictions (with no Missouri home health tuberculosis-testing rule), and infection control education for staff, patients and caregivers.

Read the full policy
Missouri rules

What Missouri's home health rules ask your policies to cover

  • Federal standards as state law. Every licensed agency must strictly meet the Medicare home health Conditions of Participation, and state licensure surveys follow Medicare standards. 19 CSR 30-26.010(1)(A)
  • Plan of treatment. Each plan covers no more than 60 days and is reviewed at least every 60 days, and a physician reviews it at least once every six months. RSMo 197.400(10); 42 CFR §484.60(c)
  • Dementia training. Dementia-specific training at orientation and every year for employees and independent contractors who give direct care to, or have daily contact with, patients with Alzheimer's disease or related dementias. 19 CSR 30-26.010(1)(B); RSMo 192.2000
  • Background checks. A criminal background check and an Employee Disqualification List inquiry before any patient contact, and Family Care Safety Registry registration for nurses and aides within 15 days of starting work. RSMo 192.2495; RSMo 210.906
  • Abuse and neglect. Agency staff who have reasonable cause to suspect abuse or neglect of a patient report it immediately to DHSS. Failing to report is a class A misdemeanor. RSMo 192.2405; RSMo 565.188
  • Surveys and corrections. DHSS sends the deficiency list within 15 business days of the survey, and the agency sends a written plan of correction within 10 calendar days of receiving it. 19 CSR 30-26.010(2)(E)

Questions a surveyor may ask

Every policy lists questions a surveyor may ask about it, so your staff can practice the answers. A few from this manual:

For this patient, when was the referral received and when was the initial assessment visit made? MO-HH-ADM-02Initiation of Care and the Initial Assessment Visit This plan is signed by a nurse practitioner. When did a physician last review it? MO-HH-CP-01Plan of Care and Care Planning What is the number for reporting, and is it the same as your complaint hotline? MO-HH-SG-01Abuse, Neglect, and Exploitation of Patients: Mandated Reporting to the Department Show me the dementia training this aide received at orientation and in the last year. MO-HH-HR-02Dementia-Specific Training for Staff and Independent Contractors Show me the plan of correction for your last survey and the evidence that each correction was made and sustained. MO-HH-GOV-05Surveys, Complaint Investigations, Deficiencies, and Plans of Correction
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Browse all 57 policies

Search by title, policy number or rule. Open any policy to see its summary, the rules it follows and what is inside.

All 57 policies

Client rights6

MO-HH-CMP-01Free sample Complaints and Grievances, and the State Home Health Hotline Sets out how patients, representatives, caregivers and families can complain to the Agency or to the Missouri Department of Health and Senior Services; how the Agency logs, acknowledges, investigates, resolves and documents every complaint within its own time frames (5 to acknowledge and 30 to resolve); how it protects patients from retaliation during and after an investigation; and how complaints alleging abuse, neglect or misappropriation are reported to the Department at once, under 42 CFR §484.50(e) as adopted by 19 CSR 30-26.010(1)(A), 19 CSR 30-26.010(2)(H) and RSMo §197.435. 42 CFR §484.50(e)(1) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-DC-02 Transfer and Discharge Notice, Including Discharge for Cause and Medicare Beneficiary Notices Sets out the only reasons for which the Agency may transfer or discharge a patient under 42 CFR §484.50(d), the written notice given before care is reduced or ended, the Agency's written discharge-for-cause policy with the four steps the rule requires before such a discharge, safe transfer when needs exceed the Agency's capability, and, if the Agency is Medicare-certified, the CMS notices (ABN, HHCCN, NOMNC and DENC) and the expedited determination process through the Quality Improvement Organization. 42 CFR §484.50(d) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-PR-01 Patient Rights and Responsibilities Sets out the rights of every patient of the Agency and how they are protected: the written notice of rights and responsibilities, the transfer and discharge policies, the Administrator's contact details and the OASIS privacy notice given during the initial evaluation visit before care starts, the patient's signature confirming receipt, the copy to a patient-selected representative within 4 business days, who may exercise the patient's rights, the twelve rights in 42 CFR §484.50(c), the Missouri home health hotline and local advocacy contacts, and the Missouri protection against retaliation for reporting. 42 CFR §484.50 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-PR-02 Advance Directives, Durable Power of Attorney for Health Care, and Outside-the-Hospital Do-Not-Resuscitate Orders Sets out how the Agency gives every adult patient written information about the right to accept or refuse treatment and to make advance directives before care is provided, records whether the patient has one, never conditions care on it, and follows Missouri law on life support declarations (RSMo Chapter 459), durable powers of attorney for health care (RSMo §§404.800 to 404.872) and outside-the-hospital do-not-resuscitate orders (RSMo §§190.600 to 190.621), including what staff do if a patient stops breathing. 42 CFR §489.102 MO-HH-PR-03 Patient Agreement, Informed Consent, and Disclosure of Charges Sets out how the Agency obtains the patient's informed consent to care and keeps it current, signs a written services agreement, tells the patient orally and in writing before care starts what Medicare, MO HealthNet or another program is expected to pay and what the patient may have to pay, gives changes as soon as possible and before the next visit, gives written notice before possibly non-covered care, never bills a MO HealthNet participant for covered services, and tells MO HealthNet participants that electronic visit verification is a condition of services. 42 CFR §484.50(c)(4) and (c)(7) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-PR-04 Language Access, Accessibility, and Effective Communication Sets out how the Agency gives information to patients in plain language and in a way that is accessible and timely: free qualified interpreters and written translations for people with limited English proficiency, free auxiliary aids and services for people with disabilities, the limits on using family members and children to interpret, Relay Missouri, and how the need is identified, recorded and met at every visit. 42 CFR §484.50(f) (adopted by 19 CSR 30-26.010(1)(A))

Service delivery7

MO-HH-ADM-01 Referral Intake and Patient Acceptance to Service Sets out how the Agency receives and records referrals, the written acceptance-to-service criteria it applies consistently to every prospective patient (anticipated needs, caseload and case mix, staffing levels, and staff skills and competencies), who decides, what happens when a referral cannot be accepted or cannot be started on time, the accurate public information the Agency keeps about its services and their limits, and the annual review of both, as 42 CFR §484.105(i) requires of every Missouri-licensed agency. 42 CFR §484.105(i) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-ADM-02 Initiation of Care and the Initial Assessment Visit Sets out how care begins: the registered nurse (or, for therapy-only cases, the therapist) makes the initial assessment visit within 48 hours of referral, within 48 hours of the patient's return home, or on the ordered start of care date, and within the Agency's own start-of-care time frame; gives the rights packet and other notices before any care; determines immediate care and support needs and, for Medicare patients, eligibility and homebound status; confirms orders; and starts the comprehensive assessment and plan of care. 42 CFR §484.55(a) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-ADM-03 Medicare and MO HealthNet Eligibility, Face-to-Face Encounter, and Homebound Status Sets out how the Agency confirms that each patient meets the coverage rules of the program expected to pay: for Medicare, the qualifying conditions in 42 CFR §409.42, homebound status verified at the initial assessment visit and the comprehensive assessment, and the physician or allowed practitioner certification and face-to-face encounter in 42 CFR §424.22; for MO HealthNet, the conditions, face-to-face encounter, visit definition and visit limits in 13 CSR 70-90.010 and 42 CFR §440.70; and what happens when a patient does not qualify. 42 CFR §424.22 MO-HH-CC-01 Coordination of Care, Case Conferences, and Written Information to the Patient Sets out how the Agency coordinates each patient's care: communication with every physician and allowed practitioner involved, integration of their orders and of services given directly or under arrangement, involvement of the patient and caregivers, ongoing education, case conferences (held as the Agency's own standard at each recertification and whenever the patient's condition or plan changes significantly), summary reports, coordination with other providers, and the written visit schedule, medication schedule, treatments, instructions and clinical manager contact details given to every patient under 42 CFR §484.60(e). 42 CFR §484.60(d) and (e) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CC-02 After-Hours Care, On-Call, and Clinical Manager Availability Sets out the Agency's operating hours at its business location, how it makes sure the Administrator (or the pre-designated person) and a clinical manager are available during all operating hours, and the Agency's own 24-hour on-call registered nurse service: the after-hours number, call-back and triage, after-hours visits, contacting practitioners, hand-off to the clinical manager, and monthly testing. 42 CFR §484.105(b)(1)(iii) and (b)(3) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CS-01 Scope of Home Health Services Defines the home health services the Agency provides under its Missouri license (RSMo §197.400(4)): skilled nursing and at least one other therapeutic service, at least one of them furnished directly, on a part-time or intermittent basis in the patient's residence, to current clinical practice guidelines. It also sets how the Agency keeps its services within its license and its capacity, publishes accurate information about them, applies the MO HealthNet home health limits, and adds or stops a service. RSMo §197.400(4) MO-HH-DC-01 Discharge Planning, Transfer, and Transition Summaries Sets out the Agency's discharge planning process from admission onward: helping patients transferred to another home health agency or discharged to a SNF, IRF or LTCH choose a post-acute care provider using quality and resource use data, the steps for a planned discharge, sending all necessary medical information to the receiving provider, the discharge summary within 5 business days of discharge, transfer summaries within 2 business days of a planned or (once known) unplanned transfer, answering requests for more information, and discharge at death. 42 CFR §484.58 (adopted by 19 CSR 30-26.010(1)(A))

Clinical tasks11

MO-HH-AID-01 Home Health Aide Qualifications, Training, and Competency Evaluation Sets out who may work as a home health aide for the Agency (the four qualification routes in 42 CFR §484.80(a), including a Missouri certified nurse assistant in good standing on the state registry), the 24-month lapse rule, the 75-hour training program content if the Agency trains aides, the competency evaluation by a registered nurse with the five skills that must be observed, the rules for unsatisfactory ratings, at least 12 hours of in-service training in each 12-month period, instructor qualifications, and when the Agency is barred from offering training or competency programs. 42 CFR §484.80(a) to (f) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-AID-02 Home Health Aide Assignment, Written Instructions, and Supervision Sets out how a registered nurse or therapist assigns each aide to a specific patient with written patient care instructions, what aides may and may not do, how aides report changes, and the supervisory schedule in 42 CFR §484.80(h): for patients also receiving skilled services, a supervisory assessment at least every 14 days (rarely by two-way audio-video, not more than once per patient in a 60-day episode) and an annual on-site observation of each aide; for patients receiving aide services only, an on-site RN visit every 60 days and a semi-annual on-site observation; plus retraining when a deficiency is verified. 42 CFR §484.80(g) and (h) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-ASM-01 Comprehensive Assessment and Reassessment Sets out who completes the patient-specific comprehensive assessment and when each one is due (no later than 5 calendar days after the start of care; in the last 5 days of every 60 days; within 48 hours of return home from a hospital admission of 24 hours or more, or on the ordered resumption date; at discharge; and whenever a major decline or improvement warrants), what it must contain under 42 CFR §484.55(c), including the drug regimen review, caregivers, the representative and the OASIS items, the individual emergency plan, and how the findings drive the plan of care. 42 CFR §484.55 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-ASM-02 OASIS Data Collection, Accuracy, Privacy, and Transmission Sets out how the Agency collects the OASIS items as part of every comprehensive assessment, which patients and time points are included under the CMS all-payer policy, the OASIS privacy notice, accuracy and correction of OASIS data, encoding and transmission to the CMS system within 30 days of completing the assessment (if the Agency is Medicare-certified), secure transmission, and the confidentiality of patient-identifiable OASIS information. 42 CFR §484.45 MO-HH-CP-01 Plan of Care and Care Planning Sets out how each patient's individualized written plan of care is developed from the comprehensive assessment with the patient, established and signed by a physician or allowed practitioner, and kept current: the sixteen required elements, patient-specific measurable outcomes and goals, recording every order, sending and tracking the plan for signature, review and revision at least every 60 days, the Missouri requirement that a physician review the plan of treatment at least once every six months, MO HealthNet plan of care rules, and how revisions are communicated. 42 CFR §484.60(a) to (c) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CS-02 Skilled Nursing Services and Missouri Nursing Practice Sets out how the Agency furnishes skilled nursing: only registered nurses and licensed practical nurses licensed where they practice (a Missouri license or a Nurse Licensure Compact multistate license), working within the Missouri Nursing Practice Act and the Agency's policies; the responsibilities 42 CFR §484.75(b) gives skilled professionals; what only a registered nurse may do; how licensed practical nurses are directed and supervised; competency for high-risk procedures; visit standards; and the MO HealthNet skilled nursing rules. 42 CFR §484.75 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CS-03 Therapy and Medical Social Services Sets out how the Agency furnishes physical therapy, occupational therapy, speech-language pathology and medical social services: qualified and licensed professionals; therapy-only assessments; measurable, objective therapy goals and functional reassessment by a qualified therapist; supervision of therapy assistants and social work assistants; the Medicare coverage rules that apply if the Agency is Medicare-certified; and the MO HealthNet therapy limits. 42 CFR §484.75 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CS-04 Laboratory Services and Waived Testing Sets out when the Agency may perform laboratory tests (only under the right CLIA certificate, such as a Certificate of Waiver for waived tests), how nurses help patients use their own FDA-cleared self-test devices without substituting Agency equipment, how specimens are collected, labeled and sent only to CLIA-certified laboratories, and how results reach the ordering practitioner. 42 CFR §484.100(c) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-CS-05 Death in the Home and Care at the Time of Death Sets out what staff do when a patient is found dead or dies during a visit: honoring a valid Missouri outside-the-hospital do-not-resuscitate order or identification, otherwise calling 911 and starting CPR if trained; immediately contacting the county coroner or medical examiner as RSMo §58.451.2 or §58.720.2 requires for a death outside a licensed facility; notifying the practitioner, family and clinical manager; protecting the scene of an unexpected or suspicious death; handling medications and equipment; and completing the discharge record. 42 CFR §484.50(d)(6) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-MED-01 Medication Management, Drug Regimen Review, Agency-Held Drugs, and Vaccines Sets out the drug regimen review in every comprehensive assessment and update, the written medication schedule every patient receives, how nurses administer medications only as ordered, the limits on aide help with medications, the drugs a Missouri home health agency and its nurses may possess without a pharmacy permit under 20 CSR 2220-2.010(5) (and the policies that rule requires), influenza and pneumococcal vaccines, patients' controlled substances and safe disposal, and medication errors and reactions. 42 CFR §484.55(c)(5) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-ORD-01 Physician and Allowed Practitioner Orders and Verbal Orders Sets out who may order home health services for the Agency's patients (physicians, podiatrists for the plan of care, and allowed practitioners: nurse practitioners, clinical nurse specialists and physician assistants, within their Missouri scope of practice), that drugs, services and treatments are given only as ordered, who may accept a verbal order, how it is read back, recorded, signed, dated and timed, the Agency's own time frame for the practitioner to authenticate it (14 days), and how unclear orders, standing orders and the Medicare and MO HealthNet signature rules are handled. 42 CFR §484.60(b) (adopted by 19 CSR 30-26.010(1)(A))

Safeguarding2

MO-HH-SG-01Free sample Abuse, Neglect, and Exploitation of Patients: Mandated Reporting to the Department Sets out how every staff member recognizes and immediately reports suspected abuse, neglect, financial exploitation, bullying, mistreatment, misappropriation and injuries of unknown source to the Missouri Department of Health and Senior Services, as RSMo §192.2405 requires of home health agencies and their employees and 42 CFR §484.50(e)(2) requires of all home health staff; what the Agency does to protect the patient and cooperate with the Department; the protections for reporters; and the penalty for failing to report. RSMo §192.2405 MO-HH-SG-02 Child Abuse and Neglect Reporting Sets out how staff immediately report to the Missouri Children's Division any reasonable cause to suspect that a child (a patient under 18, or a child in a patient's home) has been or may be abused or neglected, as RSMo §210.115 requires of nurses, other health practitioners and social workers and as the Agency requires of every staff member; that no internal investigation may begin until the report is made; that no supervisor may impede a report; and the immunity and penalties in RSMo §§210.135 and 210.165. RSMo §210.115

Infection control3

MO-HH-IC-01Free sample Infection Prevention and Control Program Sets out the Agency's documented infection prevention and control program: standard precautions and accepted standards of practice, bag technique and equipment cleaning, transmission-based precautions and respirator use, agency-wide surveillance, investigation and an action plan built into QAPI, reporting of communicable diseases to the local health authority or the Department within the time frames in 19 CSR 20-20.020, staff health and work restrictions (with no Missouri home health tuberculosis-testing rule), and infection control education for staff, patients and caregivers. 42 CFR §484.70 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-IC-02 Bloodborne Pathogens Exposure Control Plan and Hepatitis B Vaccination The Agency's written exposure control plan under the OSHA bloodborne pathogens standard: exposure determination, engineering and work practice controls including safer sharps, personal protective equipment, hepatitis B vaccination made available at no cost within 10 working days of initial assignment (with the mandatory Appendix A declination), confidential post-exposure evaluation and follow-up made available immediately, training at initial assignment and at least annually, the sharps injury log, and medical and training record retention, reviewed and updated at least annually with input from frontline staff. 29 CFR §1910.1030 MO-HH-IC-03 Sharps, Medical Waste, and Patient Instruction on Disposal Sets out how staff handle and discard sharps and other regulated or infectious waste they generate in patients' homes, how the Agency packages, transports (in a closed and secured vehicle, as Missouri's infectious waste rule allows for home health staff) and disposes of that waste through licensed transporters and permitted facilities with tracking documents, and how staff teach patients and families to package and dispose of their own household sharps and waste under the single-family residence exemption in 10 CSR 80-7.010(1)(C)2. 42 CFR §484.70(a) (adopted by 19 CSR 30-26.010(1)(A))

Emergency preparedness1

MO-HH-EP-01 Emergency Preparedness Program Sets out the Agency's all-hazards emergency preparedness program under 42 CFR §484.102 as adopted by 19 CSR 30-26.010(1)(A): the risk assessment and emergency plan, individual emergency plans for every patient as part of the comprehensive assessment, the patient priority list and information for state and local officials, continuity of operations with delegations of authority and succession, the communication plan, the medical documentation system, emergency staffing, training and exercises, and review of the program every year as the Agency's own standard (the federal minimum is every 2 years). 42 CFR §484.102 (adopted by 19 CSR 30-26.010(1)(A))

Records1

MO-HH-REC-01 Clinical Records: Content, Authentication, Retention, and Protection Sets out what every clinical record must contain, how entries are written, signed, dated, timed and corrected, how quickly visit notes, discharge summaries and transfer summaries are completed, how records are stored and protected against loss and unauthorized use, and how long they are kept (at least six years after discharge), under 42 CFR §484.110 as adopted by 19 CSR 30-26.010(1)(A) and the MO HealthNet documentation and retention rules in 13 CSR 70-3.030. 42 CFR §484.110 (adopted by 19 CSR 30-26.010(1)(A))

Privacy4

MO-HH-PRV-01 HIPAA Privacy and OASIS Confidentiality Sets out how the Agency protects the privacy of patient health information under the HIPAA Privacy Rule and keeps OASIS data confidential under 42 CFR §484.40: the privacy official and complaint contact, the notice of privacy practices and acknowledgment, minimum necessary, sharing with family and caregivers, patients' privacy rights, safeguards in the home and the office, training, sanctions, mitigation and the six-year documentation rule. 45 CFR §164.530 MO-HH-PRV-02 HIPAA Security Sets out the administrative, physical and technical safeguards the Agency uses to protect electronic patient information under the HIPAA Security Rule: the security official, risk analysis and risk management, workforce access, point-of-care devices and passwords, audit controls, transmission security, OASIS transmission, security incidents, contingency planning and backup, business associates, and six-year documentation. 45 CFR §164.308 MO-HH-PRV-03 HIPAA and Missouri Breach Notification Sets out how the Agency responds when patient or personal information may have been lost, stolen or seen by the wrong person: immediate internal reporting, containment, the four-factor HIPAA risk assessment, notice to patients without unreasonable delay and no later than 60 calendar days after discovery, notice to the media and to HHS where the HIPAA thresholds are met, the law enforcement delay, and the Missouri breach notice law (RSMo §407.1500), including notice to the Missouri attorney general and consumer reporting agencies when more than 1,000 Missouri residents are notified at one time. 45 CFR §164.404 MO-HH-REC-02 Patient Access to Records, Copies, and Release of Information Sets out how patients and their personal representatives get to see and receive copies of their records (free of charge at the next home visit or within 4 business days under 42 CFR §484.110(e)), how other requests for access are handled within the HIPAA time limits, what Missouri law (RSMo §191.227) allows for fees and for records of deceased patients, when the Agency may release information to others with or without the patient's authorization, and how amendment and accounting requests are handled. 42 CFR §484.110(e) (adopted by 19 CSR 30-26.010(1)(A))

Human resources6

MO-HH-HR-01 Personnel Policies, Qualifications, Orientation, and Performance Evaluation Sets the Agency's personnel standards: written job descriptions and the qualifications in 42 CFR §484.115 for every discipline, the hiring steps that must be finished before patient contact, orientation content (including Missouri dementia-specific training, emergency preparedness, infection control and abuse reporting), in-service training, identification, annual performance evaluation, conduct, and employee health, for every Missouri-licensed agency under 19 CSR 30-26.010(1)(A). 42 CFR §484.115 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-HR-02 Dementia-Specific Training for Staff and Independent Contractors Sets out the Missouri dementia-specific training the Agency gives to employees and independent contractors who provide direct care to, or may have daily contact with, patients with Alzheimer's disease or related dementias: the required topics for each group, training at orientation and every year, updates as needed, and the qualifications of the instructor, under 19 CSR 30-26.010(1)(B) and RSMo §192.2000.7. 19 CSR 30-26.010(1)(B) MO-HH-HR-03 Personnel Records Lists what the Agency keeps in each personnel record to prove that every staff member is qualified, screened, trained and competent, how separate confidential files (medical, I-9, background results) are kept, who may see them, how they are kept current, how long they are kept, and how the Agency answers a former employee's service letter request under RSMo §290.140. 42 CFR §484.115 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-HR-04 Criminal Background Checks, Employee Disqualification List, and Family Care Safety Registry Sets out the Missouri screening every person must pass before contact with patients: applicant disclosure and consent, a Missouri State Highway Patrol criminal background check (and a nationwide fingerprint check for applicants who have not lived in Missouri for five consecutive years), an Employee Disqualification List inquiry, and Family Care Safety Registry registration within 15 days of hire; which findings bar employment, the good cause waiver, ongoing duties and the penalties under RSMo §§192.2490, 192.2495 and 210.900 to 210.936. RSMo §192.2495 MO-HH-HR-05 Professional License Verification, Registry Checks, and Reports to Licensing Boards Requires primary-source verification of every professional license, certification and registry listing before hire and at each renewal, bars work with a lapsed or restricted license, explains the Nurse Licensure Compact, and sets out the Agency's duty under RSMo §383.133 to report to the licensing authority, within fifteen days of the final action, any disciplinary action against a health care professional or a resignation in the face of complaints that might have led to discipline. RSMo §383.133 MO-HH-SAF-01 Staff Safety in the Home, Workplace Violence Prevention, and Work Injuries Sets out how the Agency keeps staff safe while they work in patients' homes and on the road: safety screening at intake, visit planning and check-in, the right to leave or decline to enter an unsafe home without retaliation, a workplace violence prevention program, safe patient handling, driving, and how work injuries are reported and recorded under Missouri workers' compensation law (written notice within 30 days, employer report to the insurer within five days, report to the Division within 30 days) and OSHA rules (log entries within seven calendar days; fatalities reported to OSHA within eight hours, and in-patient hospitalizations, amputations and losses of an eye within 24 hours). 29 U.S.C. §654(a)(1)

Governance8

MO-HH-GOV-01 Governing Body, Organization, and Lines of Authority Sets out how the governing body of the Agency holds full legal authority and responsibility for the Agency's management and operation, services, fiscal operations, budget and quality program, how it adopts and reviews bylaws and policies, and how the Agency keeps a written organizational structure with lines of authority down to the staff member in the patient's home, as 42 CFR §484.105 and §484.65(e) require of every Missouri-licensed agency through 19 CSR 30-26.010(1)(A). 42 CFR §484.105(a) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-GOV-02 Administrator, Alternate Administrator, and Clinical Manager Names the people who run the Agency day to day and who oversee patient care: the Administrator, the pre-designated alternate who acts when the Administrator is not available, and the clinical manager and alternate, with their qualifications, written designations, duties and availability during all operating hours, as 42 CFR §484.105(b) and (c) and §484.115 require of every Missouri-licensed agency. 42 CFR §484.105(b) and (c) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-GOV-03 State License, Annual Renewal, Posting, and Statistical Reports Explains when Missouri requires a home health agency license, what the license covers, how the Agency keeps a business location with established hours, renews the license every year with the $600 fee and a statement of changes before it expires, posts the license, and submits the statistical reports the Department requires, under RSMo §§197.405 to 197.420 and 19 CSR 30-26.010(2). RSMo §197.415; 19 CSR 30-26.010(2)(A) to (C) MO-HH-GOV-04 Change of Ownership, Branch Offices, and Reporting Changes Sets out what the Agency does before a sale, transfer of ownership or management, or substantial change in corporate status (a new license applied for at least 90 calendar days ahead, because the old license is voided), how patients are told and given a choice of provider, how branch offices are approved and reported, and which other changes are reported to the Department, CMS and MMAC. RSMo §197.420; 19 CSR 30-26.010(2)(D) MO-HH-GOV-05 Surveys, Complaint Investigations, Deficiencies, and Plans of Correction Sets out how the Agency receives Department surveyors (surveys may be unannounced and follow Medicare standards), what staff do during a survey or complaint investigation, how the Agency answers the deficiency list with a written plan of correction within 10 calendar days of receiving the report, how it may dispute findings, and how corrections are checked and reported to the governing body. 19 CSR 30-26.010(2)(E) MO-HH-GOV-06 Services Under Arrangement and Contracted Personnel Sets out how the Agency furnishes services through other agencies, organizations or individuals under written agreements while keeping overall responsibility for those services and how they are furnished, screens every contractor for exclusion and Missouri background check requirements, and supervises contracted aides and professionals as if they were employees. 42 CFR §484.105(e) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-GOV-07 Voluntary Termination of the License, Agency Closure, and Disposition of Records Sets out how the Agency closes or gives up its license safely: the written request to the Department on letterhead with the license number, effective date, disposition of the active caseload and location of record storage, return of the voided license, notice and safe transfer of every patient, and keeping clinical and MO HealthNet records for the full retention period after closure. 19 CSR 30-26.010(2)(G) MO-HH-GOV-08 Nondiscrimination and Civil Rights Compliance Commits the Agency to admit, treat, and employ people without discrimination; to provide auxiliary aids and language services at no cost; to keep civil rights compliance records for Medicare, MO HealthNet and the Office for Civil Rights; and to handle discrimination complaints, under Section 1557, Title VI, Section 504, the Age Discrimination Act, the ADA, the Missouri Human Rights Act and 42 CFR §484.50(c)(11) and (f). Section 1557 of the Affordable Care Act (45 CFR Part 92)

Quality2

MO-HH-QA-01 Quality Assessment and Performance Improvement (QAPI) Sets out the Agency's effective, ongoing, agency-wide, data-driven quality assessment and performance improvement (QAPI) program under 42 CFR §484.65 as adopted by 19 CSR 30-26.010(1)(A): who leads it, the quality indicators it measures (including emergent care use, hospital admissions and readmissions, and adverse events), how data are used, how problems are corrected, performance improvement projects, the governing body's executive responsibilities, and, if the Agency is Medicare-certified, its part in the Home Health Quality Reporting Program and the expanded Home Health Value-Based Purchasing Model. 42 CFR §484.65 (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-QA-02 Incident Reporting, Investigation, and Adverse Events Sets out what staff report as an incident, what they do in the first minutes and hours, how the clinical manager investigates and analyzes causes, how abuse, neglect, misappropriation and injuries of unknown source are reported at once to the Department, and how incidents feed the QAPI program, under 42 CFR §484.65(a)(2) and (c)(2) and §484.50(e) as adopted by 19 CSR 30-26.010(1)(A) and RSMo §192.2405. 42 CFR §484.65(c)(2) (adopted by 19 CSR 30-26.010(1)(A))

Business4

MO-HH-BUS-01 Institutional Planning: Overall Plan, Operating Budget, and Capital Expenditure Plan Sets out how the Agency, under the direction of the governing body, prepares an overall plan and a budget that includes an annual operating budget and a capital expenditure plan for at least three years, through a committee of the governing body, administrative staff and medical staff (if any), reviewed and updated at least once a year, with the financial oversight and records that support it. 42 CFR §484.105(h) (adopted by 19 CSR 30-26.010(1)(A)) MO-HH-BUS-02 Charges, Billing, Claims, and Overpayments Sets out how the Agency tells patients what will be paid and what they may owe, meets the MO HealthNet home health payment conditions in 13 CSR 70-90.010 (orders with a face-to-face encounter, a plan of care reviewed at least every 60 days, visit limits) and the Medicare conditions where it is certified, reviews every claim before billing, accepts MO HealthNet payment as payment in full, and reports and returns overpayments on time. 13 CSR 70-90.010 MO-HH-BUS-03 Electronic Visit Verification for MO HealthNet Home Health Services Sets out how the Agency uses an approved electronic visit verification (EVV) system for every MO HealthNet home health visit (nursing, therapy and aide visits; supplies are exempt), identifies each worker by Family Care Safety Registry number, sends visit data to the state EVV Aggregator Solution at least daily, logs in to the aggregator at least weekly, limits and justifies manual entries, reports suspected falsification to MMAC within two business days, and keeps EVV data for six years. From June 1, 2026, home health claims without a matching EVV visit are denied. 13 CSR 70-3.320 MO-HH-BUS-04 MO HealthNet Enrollment, Documentation Standards, Records Requests, and Annual Attestation Sets out the MO HealthNet rules that apply to the Agency as an enrolled provider: keeping enrollment current (changes within 90 days, ownership or control within 30 days), the "adequate documentation" standard and contemporaneous documentation within five business days, producing records within ten business days of a request, keeping records at least six years from the date of service, the annual Deficit Reduction Act attestation by March 1, and the administrative actions MO HealthNet may take. 13 CSR 70-3.030

Ethics2

MO-HH-ETH-01 Compliance Program, Exclusion Screening, and False Claims Prevention Sets up the Agency's compliance program: oversight by the Administrator and governing body, a code of conduct, safe ways to report concerns without retaliation, monthly exclusion screening of staff and contractors, auditing, investigation and repayment, and the written information on the federal and Missouri false claims laws and whistleblower protections that Section 6032 of the Deficit Reduction Act requires and MMAC's annual attestation confirms. 42 U.S.C. §1396a(a)(68) MO-HH-ETH-02 Referrals, Kickbacks, Patient Inducements, and Accurate Marketing Prohibits paying, offering, soliciting or accepting anything of value for referrals under Missouri's health care fraud law and the federal Anti-Kickback Statute, limits gifts and inducements to patients, requires written fair-market-value arrangements with referral sources, protects each patient's free choice of provider, and requires marketing and public information about services and their limits to be accurate, as 42 CFR §484.105(i)(2) requires. RSMo §191.905
Questions

Questions about this manual

Is this the right manual for my license?

It is for home health agencies licensed by DHSS. Missouri applies the federal Conditions of Participation to every licensed agency, so the manual is written to them whether or not you are Medicare-certified. In-home services providers need the Missouri home care manual, and hospices need the Missouri hospice manual.

What does Missouri add to the federal rules?

A few things: the license, its renewal and posting; a new license applied for at least 90 calendar days before a change of ownership; dementia-specific training at orientation and every year; background and registry checks; mandated abuse reporting to DHSS; and a physician review of the plan of treatment at least once every six months (RSMo 197.400 to 197.478; 19 CSR 30-26.010).

Is there a Missouri notice period before a home health discharge?

Missouri sets none for home health. The 21-day notice in the in-home services rules does not apply to home health agencies. The policy follows the federal discharge rules (42 CFR §484.50(d)) and adds a written notice at least 5 calendar days before a planned discharge, labeled as your agency's own standard so you can change it.

What do the 57 policies cover?

Client rights (6), service delivery (7), clinical tasks (11), safeguarding (2), infection control (3), emergency preparedness (1), records (1), privacy (4), human resources (6), governance (8), quality (2), business (4) and ethics (2).

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