Ask Mary | August 2024

We are a Medicare Certified Home Health Agency and would like to know if we need to notify CMS if we use contracted staff for home health services? 

Answer:  California passed AB 5 which requires that all contracted staff, with the exception of physicians, must be employed by the entity in which the home health agency contracts with and must follow the Medicare Conditions of Participation which specify that at least one discipline is provided directly (not contracted).  The agency must also incorporate California’s requirements for service under agreement which specify:  

(a) When any service offered by the agency is not provided by employees, there shall be a written agreement meeting the requirements of this section. 

(b) The agreement shall include at least the following: 

(1) The nature and scope of the services to be provided; 

(2) The rights and responsibilities of the agency or individual providing services and of the contracting agency in the coordination, supervision, and evaluation of the care or services provided; 

(3) The role, if any, of the agency and the contracted individual or agency in: 

(A) The patient admission process, 

(B) Patient assessment, 

(C) The development, review, and revision of the plan of treatment or plan of care, 

(D) Patient care conferences, 

(E) The scheduling of visits or hours, 

(F) Discharge planning; 

(4) The submission to the agency of documentation of services provided; 

(5) The responsibility of the contracted individual or agency to adhere to applicable agency policies, including personnel qualifications; 

(6) The procedures for determining charges and reimbursement; and 

(7) The term of the agreement and the conditions for its renewal or termination. 

(c) Agreements shall be reviewed and revised as necessary.