(CMS-10539) Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA)

OMB 0938-1299

Home health agencies are required to maintain certain documentation within their own agency records that demonstrates compliance with specific Conditions of Participation for the Medicare program. This documentation is maintained on-site for use in the home health agency survey process.

The latest form for (CMS-10539) Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies (HHA) expires 2021-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-10539 HHA Final Supporting Statement 1-12-21.docx Supporting Statement A
484.58(b)(2)
484.70
484.65(d)
484.60(e)
484.60(c)
484.60(a)
484.110(a) - content of clinical records
484.105(h)
484.105(h) - existing
484.100(a) - new agencies
484.100(a) - existing
484.80(d) - in-service training
484.80(b) - home health aide classroom and practical training
484.80(c) - compentency evaluation
484.80(a)
484.65(e) - quality assessment and performance
484.60(a) care planning
484.50(e)
484.50(a) existing agencies
484.50(a) new agencies

All Historical Document Collections

202101-0938-006 Approved without change	Revision of a currently approved collection	2021-01-19
201712-0938-006 Approved with change	Existing collection in use without an OMB Control Number	2017-12-08
201701-0938-006 Withdrawn	New collection (Request for a new OMB Control Number)	2017-01-25
201507-0938-005 Comment filed on proposed rule	New collection (Request for a new OMB Control Number)	2015-07-10

OMB Details

484.50(a) new agencies

Federal Enterprise Architecture: Health - Health Care Services