With the 2025 home health final payment rule came the admission-to-service policy — an update to the Medicare Conditions of Participation. In many ways, experts consider it a formalization of measures home health providers are already taking.

Broadly, the policy has two parts. The first part requires home health providers to develop, implement and maintain a consistent policy for how their organization accepts patients to service.

“They expect you to have four pieces to it,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told Home Health Care News. “You want to look at the anticipated needs of the patients referred, so that can be their hospitalization, their diagnoses and anything that their physician, or their care provider, writes an order for. Consider that along with your agency’s current caseload and case mix, the kind of patients that you take care of now, and how many patients you have, your staffing levels, so how many staff you have to serve your patient population, and then the skills and competency of your staff.”

For example, if a patient has a dementia diagnosis the home health company would need to consider if they have staff members that are trained to care for someone with this condition.

Barnett noted that the U.S. Centers for Medicare & Medicaid Services (CMS) will be looking for the consistent application of this policy to every patient admitted to service, so documentation will be crucial.

The second part of the policy requires providers to make the services the company provides publicly available information. 

“It’s a little ambiguous right now, but the second piece is really looking at how you display what services you have,” Barnett said. “You can talk about nursing services, but there’s an expectation that if you have the skills and expertise of one of your staff that does advanced wound care, then that would be displayed. Something that would tell people that you can handle that service. It also requires you to update this information that you publicly share, as frequently as services are changed.”

CMS is trying to address access to care barriers with its admission-to-service policy.

Though the demand for care continues to increase, providers have struggled with referral rejection rates over the years due to capacity issues that stem from staffing. In 2022, 76% of patients being referred to home health providers were not being accepted, according to data from WellSky.

Last year, 64% of industry professionals noted that their referral rejection rates have remained the same or worsened since the previous year, according to a Forcura and HHCN survey.

Mary Carr — vice president for regulatory affairs at the National Alliance for Care at Home — contended that the policy shifts the blame for these challenges onto providers.

“It’s almost as though they feel it’s our problem to solve,” she said. “We didn’t create this problem, and this policy is not going to do anything to solve the problem because the problem is capacity. It’s not a process problem.”

Carr also believes that many providers are already, unofficially, following this policy when deciding which patients the company is able to take on.

Similarly, Barnett called the policy a “formalization” of the work home health providers are already doing. She said she believes that CMS is trying to stop providers from rejecting certain kinds of patients.

“CMS is trying to make sure that agencies aren’t cherry picking patients and saying, ‘We’ll take this COPD patient over here who is the exact same as this COPD patient, but this is Medicaid, and this is not,’” Barnett said. “Those are kind of the things that they’re really trying to suss out. How agencies are making these decisions, and making sure that they’re consistently applying it across patient populations.”

However, Barnett pointed out that the policy doesn’t address timely access to care.

“If you read the COP it doesn’t talk about timely initiation of care at all,” she said. “We’ve been talking to them about referral rejections and the fact that our teams, our members, just don’t have the capacity to serve everybody. We’re really concerned there’s not enough capacity across the industry, and there needs to be work around that, and more consistent communication between referral sources and the agency.”

Carr said she thinks additional clarity is needed on how CMS plans to survey this new policy.

“I’m not quite sure how CMS is going to survey for it,” she said. “They should be issuing guidance soon, and we’ll see what they say about what the surveyors are going to be looking for.”

Ultimately, Barnett said she believes providers and CMS share the same goal of ensuring that patients receive care. Still, she said she doesn’t think the new policy is the answer.

“We see on a daily basis with all of our members, it makes a difference when home health shows up, but we don’t necessarily agree that this is going to solve the issue,” she said. “We’re concerned that CMS is going in the wrong direction. We hope that CMS will continue to look at this issue, and evolve a little bit in their thinking of how we address the referral rejections and lack of access.”