The Centers for Medicare & Medicaid Services (CMS) is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity and outcomes in the health care system. cms.gov

CMS Home Health Agency Center

Billing and Payment Policies (2/21/2025) | Medicare Claims Processing Manual (pdf)

Regulations (12/21/2023)  |  Medicare Benefit Policy Manual Chapter 7 (pdf)

State Operations Manual (SOM, 4/12/2024) | SOM Appendix B – Guidance to Surveyors: Home Health Agencies (pdf)

Conditions of Participation (COPs) on Govregs.com |  Title 42 Chapter IV-I3 Part 484 Home Health Services

Medicare Learning Network (MLN)  |  Publications & Multimedia

Medicare Fraud & Abuse (2021)  |  Medicare Fraud & Abuse: Prevent, Detect, Report (pdf)

The CMS Innovation Center develops and tests health care payment and service delivery models to improve patient care, lower costs, and align payment systems to promote patient-centered practices.

Beneficiary Rights and Protections Notices  |  FFS HHCCN  |  HHAs are responsible for issuing the following beneficiary rights and protections notices to Original Medicare (fee for service – FFS) beneficiaries when notice is required: Home Health Change of Care Notice (HHCCN) (ZIP), Advance Beneficiary Notice of Noncoverage (ABN), Notice of Medicare Non-coverage (NOMNC), Detailed Explanation of Non-coverage (DENC).

Home Health Quality Reporting Program  | Your starting point for all resources, recent news, and updates pertinent to the Home Health Quality Reporting Program.

Home Health Quality Reporting Training  |  CMS has many sources of information about Home Health Quality Reporting Program (HHQRP) for stakeholders including:  Training Materials, Training Q&As, and Special Open Door Forum (SODF) Presentations.

Ohio Department of Medicaid  |  medicaid.ohio.gov

Ohio Department of Medicaid Managed Care  |  medicaid.ohio.gov/provider/ManagedCare

Ohio Area Agencies on Aging  |  aging.ohio.gov

ODM Electronic Visit Verification  |  medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/electronic-visit-verification

Ohio Secretary of State  |  Search by Business Name  |  For new agencies, use this tool to identify if a business name is already in use.

Ohio Department of Health Home Health Agency Licensure  |   odh.ohio.gov/know-our-programs/home-health-agencies/home-health-agency-licensure

Register of Ohio Rules  |  registerofohio.state.oh.us/rules/search

There are several official sites that contain detailed provider information and ratings. While aimed at health care consumers, these sites serve as useful tools for agencies to ensure their online profile is correct, and have visibility on neighboring providers.

Care Compare  |  Medicare.gov Provider Search Portal |  You can use this tool to find and compare different types of Medicare providers (like physicians, hospitals, nursing homes, and others). Use our maps and filters to help you identify providers that are right for you.

OCHCH  |  Home Care & Hospice Resource Directory  |  Are you looking for a care provider in your area? Are you a business in need of essential services? This directory, powered by OCHCH Members, is a free, searchable resource to help you identify the connections you need.

The HIPAA Security Rule establishes national standards to protect individuals’ electronic protected health information that is created, received, used, or maintained by a covered entity or its business associate. The Security Rule requires implementation of appropriate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of electronic protected health information.

HIPAA Homepage  |  HHS.gov/HIPAA  |  The main jumping off point for all things HIPAA.

The Security Rule  |  HIPAA for Professionals/Security  |  Updates and resources specific to the Security Rule for professional use.

Security Risk Assessment Tool  |  HealthIT.gov  |  The Office of the National Coordinator for Health IT (ONC), in collaboration with the HHS Office for Civil Rights (OCR), developed a downloadable Security Risk Assessment (SRA) Tool to help guide you through the process. The tool is designed to help healthcare providers conduct a security risk assessment as required by the HIPAA Security Rule. The target audience of this tool is medium and small providers; thus, use of this tool may not be appropriate for larger organizations.

OCR’s HIPAA Audit Program  |  Compliance & Enforcement  |  The Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) requires HHS to periodically audit covered entities and business associates for their compliance with the requirements of HIPAA.

Outcome and Assessment Information Set (OASIS)

CMS OASIS Q&As – Archived pdfs of CMS question & answer sessions dating back at least one year.

CMS OASIS Data Sets – Downloadable data sets from CMS, recent and archived.

CMS OASIS User Manuals – Downloadable manuals and references from CMS, recent and archived.

ODH OASIS Training Videos – Collected training videos produced by Ohio Department of Health for provider education.

As a Medicare Administrative Contractor (MAC), Palmetto GBA (Government Benefits Administrator) is one of the nation’s largest providers of high volume claims and transaction processing, contact center operations, and technical services.

Jurisdiction M Home Health and Hospice Medicare Administrative Contractor (MAC)  |  Home Health and Hospice providers in Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas.

Local Coverage Determinations (LCDs)  |  Select “Active” for those now in effect.

New Agency Enrollment  |  Provider Enrollment in Jurisdiction M HHH  |  Your hub for enrolling as a Medicare Provider.

The following are links to regulations regarding background checks as well as seven essential databases.

Ohio Department of Aging  |  Chapter 173-9, Criminal Records Check  |  Ohio Administrative Code regarding background checks for paid direct-care positions.

Ohio Department of Developmental Disabilities  |  Rule 5123-2-02 | Background Investigations for Employment  |  This rule establishes standards for conducting background investigations on persons employed or seeking employment in Ohio’s service delivery system for individuals with developmental disabilities.

Ohio Department of Health  |  Chapter 3701-60  |  Ohio Administrative Code specific to Home Health Agencies.

Ohio Department of Medicaid  |  Rule 5160-45-07 | ODM-administered waiver programs: criminal records checks involving agency providers.