On November 7, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published a final rule (“Final Rule”) that added a new condition of participation for home health agencies (“HHA”) to participate in Medicare under the “Medicare Program; Calendar Year (“CY”) 2025 Home Health Prospective Payment System (“HH PPS”) Rate Update” for the calendar year 2025.
New Policy Requirements
In the Final Rule, CMS finalized a new standard at 42 CFR § 484.105(i) that would require HHAs to develop, implement and maintain an acceptance-to-service policy that is applied consistently to each prospective patient referred for home health care. CMS stated that the purpose of the new requirements is to address concerns regarding the referral and acceptance process and their implications for prospective and current patients.
CMS designed these new elements to inform the public of an HHA’s assessment of its capacity and determine its suitability to meet the anticipated needs of the prospective patient who has been referred for HHA services. CMS also calls for 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.
42 CFR § 484.105
Specifically, the new 42 CFR § 484.105 requires that an HHA do both of the following:
- 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: (1) anticipated needs of the referred prospective patient; (2) case load and case mix of the HHA; (3) staffing levels of the HHA; and (4) skills and competencies of the HHA staff.
- 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.
Under the Final Rule, CMS also requires HHAs to review publicly facing information as frequently as services are changed, but no less often than annually.
CMS asserts that this new requirement will create greater clarity between HHAs, patients and referral sources, may improve the HHA’s relationships with the community they serve, and reduce instances of avoidable confusion and delays.
CMS states in the preamble to the Final Rule that it expects HHAs to update the information regarding their services provided and service limitations if the HHA anticipates it will not have a service available for three to six months. Also, changing a service means the HHA has formally altered the services it offers, whether by adding, discontinuing or temporarily pausing or restricting a service. CMS offered the following 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, etc.) or the addition of a new contract employee that provides speech-language pathology services, which an HHA may not have provided before.
CMS adopted the rule because it feels that providing the most up-to-date information on services provided and service limitations will allow patients, their families and/or their caregiver(s) to make educated decisions about which HHA will best meet their physical, psychosocial and rehabilitative needs. HHAs are already required by 42 CFR § 484.105 to document, in writing, the services that they furnish. The governing body is responsible for assuring that this is done as part of their oversight responsibilities set forth in 42 CFR § 484.105(a). After publication of this final rule, CMS will provide additional guidance on enforcement through memoranda and updates to the State Operations Manual (Pub. 100–07), as needed.
Effective Date
The effective date of the Final Rule is January 1, 2025.
Practical Takeaways
- HHAs should review the Final Rule’s new requirement and develop the required acceptance-to-service policy before January 1, 2025.
If you have any questions, would like assistance preparing your HHA acceptance-to-service policy or would like additional information about this topic, please contact:
- Robert Markette at (317) 977-1454 or rmarkette@hallrender.com;
- Sean Fahey at (317) 977-1472 or sfahey@hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@hallrender.com; or
- Your primary Hall Render contact.
More information about Hall Render’s Post-Acute and Long-Term Care services can be found here.
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