Home health
Home health services under arrangement: keeping the contracts straight
Medicare's Conditions of Participation require a home health agency to have a written agreement with any agency, organization or individual furnishing services under arrangement to its patients. The agency keeps overall responsibility for those services and the way they're furnished.
So a therapy or staffing contract isn't only a business document. Surveyors can ask about it, and a lapsed one is your problem, not the vendor's.
What the rule says
Under 42 CFR 484.105(e), services furnished under arrangement must meet the same home health requirements as services your own staff provide. The agreement has to be in writing, and your agency keeps overall responsibility for the services and the manner in which they're furnished.
The rule also says who you can't use. The contractor may not have been denied Medicare or Medicaid enrollment, excluded or terminated from any federal health care program or Medicaid, had its Medicare or Medicaid billing privileges revoked, or been debarred from any government program.
And the primary agency stays responsible for patient care. Contracting out a visit doesn't contract out the responsibility.
What these agreements commonly cover
The rule doesn't hand you a list of clauses. Agencies commonly spell out which services and disciplines are covered, which counties or branches, how visits are ordered and scheduled, how and when visit notes reach your clinical record, staff licensure and competency, how you'll supervise and review the work, the rates, and the contractor's statement that it isn't excluded.
Check those against how the work really happens. If notes arrive weeks late, or visits happen without your orders, the agreement isn't the only thing to fix.
A worked example
Say a physical therapy group has seen your patients since 2023 under an agreement that expires March 31, 2027. Its rates went up in a 2025 amendment, and last year you opened a branch in a county the agreement doesn't list.
That's three things to catch at once: the expiration, the current rate sitting in the amendment, and a service area that no longer matches. Starting the renewal about 90 days out, around the first of the year, leaves time to cover the new branch before the old agreement ends.
What to watch
Do you have a current signed agreement for every arrangement?
Check for the ones running on an old contract or a handshake.
Has the contractor been checked against the exclusion lists?
The rule bars contractors that were excluded, revoked or debarred. Many agencies check the OIG exclusion list and SAM.gov at signing and on a schedule after.
Does the agreement say who orders the visits?
Your agency is responsible for the care, so services should follow your orders and plan of care.
Are rates current?
Rate changes often live in an amendment that's easy to lose.
Do you know when each ends?
A lapsed agreement with a vendor still seeing patients is the gap to catch.
Does the agreement cover your service lines?
If you've added a branch or a service, the contract may not have kept up.
How Sapphires helps
- Tag each agreement by service line, such as home health, and by category, such as therapy or staffing.
- Amendments stay attached to the agreement they change, and the contract shows the terms in effect now.
- Reminders go out before these agreements renew or expire, at checkpoints you choose.
- Each agreement can have an owner, often the clinical manager who knows how the contractor is doing.
- The signed PDF stays on the record, and a read-only auditor role can see it when it's time to show it.
42 CFR 484.105(e): home health services under arrangement
HHS OIG: exclusions program and search