Every year, CMS updates its Final Rule for home health agencies. These updates often bring new regulations, conditions, and documentation requirements.
For 2025, one of the most important changes is the new Acceptance-to-Service Policy. It's a Condition of Participation (CoP) that every Medicare-certified home health agency must follow.
If you're a home health owner or administrator, you're likely wondering:
- What exactly is this policy?
- How will CMS enforce it?
- What does this mean for how we accept patients?
In this article, we'll break everything you need to know. You'll walk away understanding what the policy is, and how to comply.
What Is the Acceptance-to-Service Policy?
CMS has added a new standard under 42 CFR § 484.105(i). This regulation requires agencies to apply an acceptance-to-service policy to all patient referrals. The condition states:
“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) Case load 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.”
Now, what the heck does that actually mean? In simpler terms, the policy must be:
- Written and implemented at the agency
- Followed consistently for every referral
- Reviewed and updated at least once per year
The goal is to ensure agencies make fair, documented decisions about every patient they accept or decline.
What Factors Must Be Considered When Admitting a New Home Health Patient?
CMS outlines four specific factors that must guide each decision:
- The anticipated needs of the patient
- The current case load and case mix at the agency
- Staffing levels at the time of referral
- The skills and competencies of available staff
Every referral should be reviewed based on these four points. If the patient is accepted, that decision should be logged. If the patient is declined, the reason must be documented clearly.
What Must Be Documented Under the New Home Health Acceptance-to-Service Policy?
Agencies are required to keep a detailed referral log.
This log should include:
- The referral date
- The patient’s anticipated needs
- The final decision (accept or decline)
- A written explanation for the decision
This documentation becomes essential if similar referrals are treated differently. Agencies must be able to explain why one patient was accepted and another was not.
The policy must be consistently applied across all patients—no exceptions.
Does a Home Health Acceptance-to-Service Policy Need To Be Public?
Yes. CMS requires agencies to make the acceptance-to-service policy publicly available.
This includes:
- Posting the policy on your agency website
- Giving the policy to every new admission
The policy should also clearly outline:
- What services your agency offers
- Any limitations on specialty services, visit frequency, or visit duration
Transparency is key. Referral sources and patients should understand what your agency can and cannot provide.
How Will CMS and Accrediting Bodies Enforce It?
Initially, surveyors from CMS and accrediting bodies like ACHC are focusing on one thing:
Does your agency have this policy in place?
CMS has not yet released detailed instructions on how to operationalize the policy. So for now, surveyors are verifying that the policy exists and aligns with the Final Rule. But that won't last forever.
Over time, agencies can likely expect surveyors to:
- Review the referral log
- Audit how referral decisions are made
- Check documentation for declined referrals
- Compare decisions made on similar cases
ACHC has stated that agencies should be ready to show how they apply the policy. They also recommend including this as part of your internal QAPI audits.
What Are the Consequences of Not Complying with the Acceptance-to-Service Policy?
Failure to comply can result in significant consequences. Because the acceptance-to-service policy is a condition, failure to comply would result in a conditional deficiency. A conditional deficiency results in survey failure.
That’s why it’s essential to not just sit around and wait for your next survey. Build and implement your policy as soon as possible.
How Can Home Health Agencies Stay on Top of Constantly Changing CMS Regulations?
Agencies must develop and follow a referral acceptance policy or face penalties. But, you’re not figuring this out alone. Many agencies are still in the early stages of implementing this rule.
The best things you can do right now are:
- review your referral process
- create or update your acceptance policy
- post the policy online
- train your staff
- consistently log and document your referrals in accordance with the policy
The Acceptance-to-Service Policy is a major update, but it’s not the only one.
CMS has also made a big change to the OASIS assessment form. Known as OASIS-E1, this version includes changes that affect:
- Patient evaluation
- Data collection
- Care planning
If your clinicians aren’t trained on these updates, your agency could fall out of compliance fast.
Want to get up to speed on OASIS-E1? Read our full breakdown of the 2025 OASIS updates below.
Need extra support creating a compliant policy? Our team is here to help.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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