Medicare Conditions of Participation
Home Health Services

5.) Home Health Services

A home health agency must operate and furnish services in compliance with all applicable federal, state, and local laws and with accepted professional standards.130 A home health agency must meet standards related to governance and services furnished.131 A home health agency’s operations must be annually reviewed by a group of professional personnel.132 Home health agencies must meet standards related to plan of care, periodic review of plan of care, and conformance with physician orders.133

A home health agency must provide the following services by qualified professionals according to professional standards of care:

• Skilled nursing services134
• Any therapy services135
• Medical social services136
• Home health aide services137
• Outpatient physical therapy or speech pathology services138

A home health agency must provide each patient with a patient-specific, comprehensive assessment that accurately reflects the patient’s current health status and includes information that may be used to demonstrate the patient’s progress toward achievement of desired outcomes.139 The assessment must identify the patient’s continuing need for home care and meet the patient’s medical, nursing, rehabilitative, social, and discharge planning needs. For Medicare beneficiaries, the home health agency must verify the patient’s eligibility for the Medicare home health benefit.

A home health agency must provide a patient with written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation before the initiation of treatment.140  A home health agency must ensure the confidentiality of all patient identifiable information contained in the clinical record.141  A home health agency must maintain clinical records for every patient, and they must be safeguarded against loss or unauthorized use.142

Home health agencies must electronically report all Outcome and Assessment Information Set (OASIS) data to the State agency or a CMS OASIS contractor.143