Home health Conditions of Participation: an overview
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
Conditions of Participation are the federal requirements a home health agency must meet to take part in Medicare. They are in 42 CFR Part 484. This page is a topic map so you can see what they cover; it is not a compliance manual and not a complete checklist. Read the eCFR text, and ask your counsel and your state survey agency.
What a Condition of Participation is
CMS describes a home health agency as an organization that, among other things, is primarily engaged in providing skilled nursing and other therapeutic services and meets the federal requirements for the health and safety of the people it serves. Those requirements are the Conditions of Participation. CMS says surveys check an agency against them to decide whether a citation of non-compliance is appropriate, and CMS publishes interpretive guidelines that explain them to surveyors.
The topic map
| eCFR section | Condition | What it covers, in brief |
|---|---|---|
| § 484.40 and § 484.45 | OASIS information | Releasing and reporting OASIS assessment information. |
| § 484.50 | Patient rights | Notice of rights, exercise of rights, transfer and discharge, complaints and accessible information. |
| § 484.55 | Comprehensive assessment | The initial assessment visit and the comprehensive assessment of each patient. |
| § 484.58 | Discharge planning | A discharge planning process and transfer or discharge summaries. |
| § 484.60 | Care planning and coordination | The individualized plan of care, conformance with orders and coordination of services. |
| § 484.65 | Quality assessment and performance improvement | An agency-wide quality program led by the governing body. |
| § 484.70 | Infection prevention and control | Standard precautions, an infection control program and education. |
| § 484.75 | Skilled professional services | Who may authorize, deliver and supervise skilled services, and their responsibilities. |
| § 484.80 | Home health aide services | Aide training, competency evaluation, in-service training, assignments and supervision. |
| § 484.100 | Compliance with laws | Federal, state and local laws, including disclosure of ownership and licensing as applicable. |
| § 484.102 | Emergency preparedness | An emergency preparedness program. |
| § 484.105 | Organization and administration | Governing body, administrator, clinical manager, branches and services under arrangement. |
| § 484.110 | Clinical records | Contents, authentication, retention, protection and retrieval of clinical records. |
| § 484.115 | Personnel qualifications | Qualifications for roles such as administrator, clinical manager, nurses, therapists and aides. |
Section names from 42 CFR Part 484 on the eCFR. The summaries are ours and leave out most of the detail. This is a map, not the rule text.
Why this matters for a founder
A non-medical home care agency does not work under these federal conditions, because it is not seeking Medicare certification. A home health agency seeking certification does, and the written policies, records, staffing and quality program it needs follow from them. homecarepolicyprocedures.com, also published by Home Care Agency Blueprint, covers written policies for non-medical home care; for a certified home health agency, work from the eCFR text with counsel.
Payment and quality programs sit alongside
Part 484 also contains the home health prospective payment system and value-based purchasing rules, and CMS runs a home health quality reporting program that uses OASIS data. We mention them only so you know they exist; confirm current requirements in CMS materials.
A planning aid, not a promise. Nothing on this site can tell you which agency to open, whether you would be licensed, or whether you would be certified. It maps the differences and points you to Medicare.gov, CMS and your state so you can check them for your own plans.
Your state sets its own rules. Whether and how your state licenses non-medical home care, home health agencies or both is a state question, and the rules can change. This site does not list state rules. Check your state licensing or survey agency; homecarelicenseguide.com, also published by Home Care Agency Blueprint, helps you research non-medical licensing. Not legal, licensing, Medicare or financial advice.
What to do next
Frequently asked questions
Does this page cover every requirement in full?
No. It is a topic map. The eCFR text, CMS guidance, your counsel and your state survey agency are the places to work from.
Where do I read the full rules?
42 CFR Part 484 on the eCFR, linked in the sources below. CMS also publishes interpretive guidelines for surveyors.
Want to talk through your options?
A free 15-minute clarity call with Home Care Agency Blueprint. It helps people start home care agencies, so expect that perspective. You do not need to have chosen a lane first.
Book a free 15-minute clarity call