CMS has issued an update for its survey guidance around home health agencies, adding details surveyors should look for in your acceptance-to-service policy.
 
While the policy has been in effect since January 2025, CMS has not updated survey guidance to reflect this requirement until now.
 
Under the requirement at §484.105(i), agencies must develop, implement and maintain through an annual review, a patient acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care, which addresses criteria related to the agency’s capacity to provide patient care, including, but not limited to, all of the following:
  • Anticipated needs of the referred prospective patient.
  • Case load and case mix of the agency.
  • Staffing levels of the agency.
  • Skills and competencies of the agency staff.
Agencies are also expected to make available to the public accurate information regarding the services offered by the agency and any limitations related to types of specialty services, service duration or service frequency.
 
Key guidance added to the State Operations Manual Appendix B includes:
 
Surveyors must review the HHA’s acceptance-to-service policy to ensure it meets all the elements within this regulation.
 
Surveyors should confirm the HHA’s acceptance to service policy includes at a minimum the four criteria listed in this requirement:
  • Anticipated needs of the referred prospective patient.
  • Case load and case mix of the HHA.
  • Staffing levels of the HHA.
  • Skills and competencies of the HHA staff.
This policy is HHA-specific and separate and distinct from the patient’s individualized plan of care at §484.60.
 
HHAs provide information regarding their services in multiple formats (for example, Care Compare, agency websites, brochures). To ensure that the information presented to the public is accurate, we are requiring HHAs to review publicly facing information whenever services are changed, but no less often than annually. We expect HHAs to update information on the services they provide and any service limitations if they anticipate not having a service available for 3 to 6 months.
 
CMS extracts information about an HHA’s services offered (including whether they provide Skilled Nursing Care, Physical Therapy, Occupational Therapy, Speech Therapy, Medical Social Worker Services, and Home Health Aides) from the CMS-1572 survey report form, where the “Services Provided” information is captured directly from facility staff. The information from this form is entered into the CMS iQIES database and serves as the source for certain CMS public reporting, such as the CMS Care Compare website. HHAs should ensure this information is completed in PECOS, then outreach to their OASIS Education Coordinator or OASIS Automation Coordinator to request that their data in iQIES be updated
 
Surveyors should note that updates to home health agency provider demographic information do not occur in real time and may take up to six months to appear on Care Compare. Therefore, as long as the HHA can provide you with evidence that they requested corrections/updates, this would not trigger a citation if Care Compare was incorrect.