The Centers for Medicare and Medicaid Services (CMS) has issued updated survey guidance on home health agencies’ acceptance-to-service policies, a new standard under the Home Health Agency Conditions of Participation that took effect in Jan. 2025.
The agency issued the guidance to home health agencies in a Wednesday memo, clarifying requirements to develop, implement and maintain an acceptance-to-service policy and make accurate information about their service offerings and service limitations public.
The required acceptance-to-service policy must include four elements: information about the anticipated needs of the referred prospective patient, the agency’s caseload and case mix, staffing levels and its staff’s skills and competencies.
“These elements inform a [home health agency’s) (HHA) assessment of its capacity and determine its suitability to meet the anticipated needs of the prospective patient referred for HHA services,” CMS’ memo read.
Agencies are responsible for working with their referral sources to educate them about the agency’s acceptance-to-service policy and its services, thereby minimizing communication gaps.
Home health agencies may tailor their policies to address additional concerns, procedural delays and challenges often experienced during the referral and acceptance process within these policies, CMS said.
“While all of a prospective patient’s needs may not be known at the time of referral, general information regarding the patient’s diagnosis and recent hospitalization (as appropriate), and specific orders from the patient’s medical provider should provide a reasonable basis for HHAs to anticipate the overall needs of the patient and determine whether, in light of the described elements that must be present in the policy, the prospective patient is or is not appropriate for the HHA to accept for service.”
Service offerings information
The requirement for agencies to publish information regarding their services also requires agencies to publish limitations related to types of specialty services, service duration or service frequency.
CMS does not mandate how home health agencies make the information available. CMS said agencies can provide the information in multiple formats, including Care Compare, agency websites and brochures.
The agency requires agencies to review the publicly facing information whenever they change services and no less often than annually. “Changing a service” means when an agency formally alters its services, which includes adding, discontinuing, temporarily pausing or restricting a service. CMS said it expects agencies to update public information when they anticipate a service will be unavailable for three to six months.
“For example, a change in service may include an employee taking an extended leave of absence (that is, care for a family member, recovery from a serious illness or procedure, maternity leave) or the addition of a new contract employee that provides speech language pathology services, which an HHA may not have provided before,” the memo read.
CMS obtains information about an agency’s services from the CMS-1572 survey report form, according to the memo, with “Services Provided” information captured from agency staff. The information is then entered into the CMS iQIES database, where it becomes the source for some CMS public reporting, including 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,” the memo read.