Conditions of Participation

When it comes to the Conditions of Participation for both home health care and hospice, there are different sources for this information.  Organizations often search the State Operations Manual (SOM) for CoPs.  However, it’s important to remember that this document is a guide for state surveyors and doesn’t contain other information such as Conditions for Coverage (CfCs).  The SOM is useful because it adds extra information as an explanation of what the surveyor should be looking for—and further defines the language used in the rule.  That information is listed under the CoP in a section titled “Interpretive Guidelines”.  The SOM also lists the G-tag for each CoP and standard.  A standard is a subpart of a Condition of Participation. The G-tag is what a surveyor references when citing an agency or hospice on their failure to meet the CoP or standard.  The various G-tags have different penalties associated with them, and a condition-level deficiency is worse than a standard-level deficiency.  At any rate, the SOM is a very useful document.

On the other hand, the Code of Federal Regulations (CFR) for each type of organization contains both the CoPs and the CfCs.  This may be useful if you are needing information regarding certain Medicare coverage rules. For instance, the home health CFR Part 484 has the CfCs for payments and HH Value Based Purchasing.  These parts are not contained in the SOM.  Hospice CoPs and CfCs are found in the CFR Part 418 and also contain payment information as well as quality reporting, the aggregate cap, and the like.  Another very useful document depending on your needs.