Home health agencies should be aware of recent updates to Appendix B of the State Operations Manual, which provides survey guidance specific to home health agencies. The changes include important additions and revisions that could affect how agencies prepare for surveys, particularly as certain requirements receive increased attention from surveyors.
For those who may not be familiar with the State Operations Manual, it serves as a key resource for surveyors conducting Medicare certification and recertification surveys. Surveyors use the manual to identify applicable tags and follow the interpretive guidelines when evaluating your organization’s compliance with Medicare requirements.
Appendix B of the State Operations Manual for Home Health was updated on July 15, 2026. While the update itself was not significant, it has resulted in a renewed focus among surveyors. It is also important to keep in mind that surveyors have come under increased scrutiny following the moratorium and the identification of fraudulent activity involving some organizations that received home health and hospice certification. As a result, we expect surveyors to be more thorough in their reviews, while also facing greater oversight from CMS than they may have experienced in the past.
With this update to the State Operations Manual for Home Health, there are a few changes to be aware of, including two additions and one revision. The two additions relate specifically to the Acceptance to Service Condition of Participation. While this requirement was introduced some time ago, it has now been incorporated into the State Operations Manual and is becoming an area of increased focus during surveys.
The first addition is G990, which reflects the new standard requiring home health agencies to develop, implement, and maintain a Patient Acceptance to Service Policy. This policy must be applied consistently to each prospective patient and address four specific areas outlined within the standard.
In addition, G992 has been added to the State Operations Manual. This requires home health agencies to make information about their services publicly available. Agencies must review and update this information whenever their services change and, at a minimum, review it annually to ensure it remains current and accurate.
In addition, G1052 has been revised to clarify the qualification requirements for home health agency administrators. Prior to January 13, 2018, an administrator could be a licensed physician, a registered nurse, or an individual with at least one year of experience in administration or supervision within a healthcare setting. For administrators appointed after January 13, 2018, the individual must be a licensed physician, a registered nurse, or hold a bachelor’s or associate degree. Those qualifying through a bachelor’s or associate degree must also have at least one year of experience in administration or supervision specifically within home health.
Those are the primary revisions included in this update to the State Operations Manual. It is important to become familiar with these changes, particularly because there appears to be increased surveyor focus on the Acceptance to Service Policy. Make sure your agency fully understands the requirements, has an appropriate policy in place, and, most importantly, is consistently following that policy when accepting referrals and admitting patients into care.
If Healthcare Provider Solutions can assist you with analyzing your Acceptance to Service Policy, please don’t hesitate to reach out to us.
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