New Home Health Standard is Coming: Are You Ready?
CMS finalized changes to add a standard into Condition of Participation §484.105, Acceptance-to-service policy, in the Final Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update. This regulatory change is effective on January 1, 2025.
The new standard, §484.105(i), requires home health agencies (HHAs) to develop and maintain a policy for evaluating new patient referrals. This policy must be applied consistently to each prospective patient. The policy must address the HHA’s capacity to provide patient care, including the HHA’s caseload, staffing levels, and staff skills and competencies. CMS also requires the patient acceptance-to-service policy to be applied consistently to ensure that HHAs only accept those patients for whom there is a reasonable expectation that the HHA can meet the referred patient’s needs. They also updated the frequency with which HHAs must review the publicly facing information regarding their services provided and any service limitations to ensure this information is up-to-date and accurate. § 484.105(i)(2), requires HHAs to review the publicly facing information as frequently as services are changed, but no less often than annually.
CHAP is revising our Home Health Standards of Excellence to incorporate this regulatory change, and we will also make our updated manual available as soon as possible.
Until then, providers are responsible for developing their policy to demonstrate compliance with §484.105(i) as of January 1, 2025.
Revised regulatory text
§ 484.105 Condition of participation: Organization and administration of services.
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(i) HHA acceptance-to-service. An HHA must do both of the following:
(1) 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 HHA’s capacity to provide patient care, including, but not limited to, all of the following:
(i) Anticipated needs of the referred prospective patient.
(ii) Caseload and case mix of the HHA.
(iii) Staffing levels of the HHA.
(iv) Skills and competencies of the HHA staff.
(2)(i) Make available to the public accurate information regarding the services offered by the HHA and any limitations related to types of specialty services, service duration, or service frequency.
(ii) Review the information specified in paragraph (i)(2)(i) of this section as frequently as the services are changed, but no less often than annually.
Please contact us if you have any questions related to this change.