Skip to Main Content


This chapter seeks to provide a framework about the multifaceted and complex realm of home care since it intersects with regulatory requirements. Government-reimbursed home care, such as the Medicare and Medicaid programs, can be complicated, multilayered, and is continually undergoing change. There are interfacing and detailed regulatory requirements included. As this book goes to press, we are awaiting the new home care Conditions of Participation (CoPs) to be released.

Whatever the detail of the rules, such as the CoPs, whether for home care or hospice, as the government and other payers move to value-based care and care models, the key focus will be on value and outcomes, the intersection of cost and quality. We are starting to see value that is attributable to detailed and skillful care. In addition, home care is practiced differently in different states, and state practice laws and licensure laws may or may not exist or may vary from state to state. There may be different laws for varying kinds of home care, such as a certified home health agency, a registry, a hospice, an infusion organization, homemaker and companion services, home medical or durable equipment companies, and staffing. For home care–specific coverage, see Appendix D for the “Medicare Benefit Policy Manual Chapter 7—Home Health Services,” beginning on p. 304. Of course, it is important to note that the Manual is sometimes updated and readers are advised to keep apprised of new updates.


Effective operations and processes can mean the difference between success and reactive problem-solving. These “problems” can span the scope from patient complaints to state regulators regarding care and services to the Office of the Inspector General (OIG) and the Federal Bureau of Investigation (FBI) involvement in suspected regulatory violations. For these and other reasons, it is imperative that home care and hospice organizations adhere to the “rules” and make effective daily operations and activities a hallmark of a well-functioning organization.

Like any business, there are missions, visions, and goals, as well as an organizational chart that should clearly designate the leadership and staff roles, functions, and responsibilities from the top down. Of course, in the home care business we serve patients, so the patient should also be listed on the organizational chart. This is also an accreditation standard that relates to all of this, and information about accreditation bodies with links for more information are listed later in this chapter.

Whether the home care program is freestanding; a part of a healthcare system, such as a hospital; or an integrated group of healthcare providers, such as part of a network or an accountable care organization (ACO), it must have the ability and functions of any successful business operation. This starts with human-resource capabilities, such as screening, interviewing, hiring, onboarding, and counseling. There are other very important fiscal functions, such as budget ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.