Important Regulatory Update Issued for Medicare Certified Home Health Agencies

The Centers for Medicare and Medicaid Services (“CMS”), the Medicare oversight agency, issued a new Chapter to the State Operations Manual (“SOM”) governing the imposition of alternative sanctions for home health agencies (“HHA”). Chapter 10 of the SOM is a new chapter outlining the processes for implementing the imposition of civil money penalties, directed in-service training, directed plans of correction, suspension of payment and temporary management. These intermediate sanctions were authorized in a final rule issued in 2012.

The SOM is utilized by CMS and its Regional Offices (“RO”) in conjunction with the State Agencies (“SA”) which provide survey and some enforcement activities on behalf of CMS. Chapter 10 also provides an informal dispute resolution process for dispute of citations by the HHA providers. This important new SOM chapter should be reviewed by all Medicare certified HHAs to understand the process for implementation of these intermediate sanctions should the agencies be cited with Condition level deficiencies or other activities that occur that may require the SA and CMS to implement these sanctions. Processes and descriptions are provided in this 40 page chapter and outline responsibilities for the SA, as well as for CMS. Chapter 10 can be found with the transmittal at and it is expected to be added soon the the CMS website link for the SOM at

For more information on the home health survey requirements, please contact Janet Feldkamp or any member of our health care practice group for a further discussion.

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