Exploring the Legal Challenges in Domestic Healthcare Support Services
Changes in Home Health Care Regulations Affect Providers, Patients, and Employees
The home health care industry is facing significant changes in regulatory compliance, provider responsibilities, patient rights, and risk management strategies. With an aging population and a growing reliance on technology, the landscape of home health care is evolving rapidly.
Regulatory Compliance Updates
One of the most notable changes is the expiration of the Hospital-at-Home (H@H) model waiver on September 30, 2025. After this date, hospitals will no longer be able to bill Fee-for-Service Medicare or Medicaid for acute care at home without Congressional action to extend it. This means providers must plan patient transitions back to physical hospitals and manage financial risk accordingly [1].
The Centers for Medicare & Medicaid Services (CMS) has also expanded its enforcement authority. Providers with affiliations to entities linked to fraud, waste, or abuse now risk having their enrollment revoked or denied. Providers must disclose such affiliations upon CMS’s request, emphasizing heightened scrutiny in provider enrollment and recertification processes [4].
Home care agencies are increasingly relying on automation and software solutions to ensure compliance with documentation, billing, Electronic Visit Verification (EVV), and caregiver certification standards. Proper documentation reduces claim denials and improper payments; CMS reported an improper payment rate of 7.38% in home health [2].
Provider Responsibilities
Providers must ensure accurate and timely documentation of care services and medication administration to avoid high rates of claim denial and improper billing. Maintaining up-to-date training and certification for caregivers is critical amid ongoing workforce shortages; improving caregiver experience is linked to better retention [2].
With the changes in the budget reconciliation law, there are limitations to Medicaid eligibility for long-term care coverage. Specifically, home equity caps will affect who qualifies for Medicaid-covered home health services starting in 2028, requiring providers to be mindful of patient financial eligibility [5]. Providers also need clear communication and logistical planning for transitions away from the H@H model back to brick-and-mortar settings in compliance with the upcoming waiver expiration [1].
Patient Rights
Recent budget provisions have shortened retroactive Medicaid coverage from three to two months, potentially jeopardizing timely access to care for patients during eligibility processing, especially those in crises or requiring long-term care [5]. Providers must respect patient dignity and rights in all service delivery, as mandated by compliance standards enforced by CMS, including obtaining informed consent, especially with evolving telehealth and home care modalities [4].
Risk Management Strategies
Agencies are adopting automation technology to reduce human error and improve adherence to complicated regulatory requirements related to billing, documentation, and visit verification [2]. The expiration of waivers like the H@H Model necessitates contingency planning for patient care transitions, handling financial risk, and minimizing disruption, which are critical risk management priorities for providers [1].
Understanding and responding proactively to CMS’s enhanced affiliation disclosure and revocation authority can mitigate provider risks of losing Medicare billing privileges [4]. The chronic staffing shortages and regulatory freezes on minimum staffing requirements in nursing facilities increase risks to patient safety, requiring vigilant monitoring and advocacy by home care providers [5].
Navigating Legal Challenges
Navigating legal challenges in home health care involves understanding complex federal and state regulations, including the Centers for Medicare & Medicaid Services' guidelines. Compliance with federal and state regulations governing home health services is crucial, such as the Health Insurance Portability and Accountability Act (HIPAA), which mandates safeguarding patient information [6].
Compliance with the Fair Labor Standards Act (FLSA) is essential for wage and hour laws. Mismanagement of employee relations can lead to litigation and reputational damage. Anti-discrimination statutes ensure equal employment opportunities regardless of race, gender, or disability [7].
The integration of telehealth services is influencing legal frameworks around patient care, raising questions regarding licensure, consent, and liability. Regulations surrounding data protection and privacy are likely to tighten as more health care providers adopt electronic health records [8].
Liability related to negligence or malpractice claims is a significant legal concern for home health care providers. Effective risk management strategies include thorough staff training programs, routine audits of care documentation, clear communication channels, and investing in comprehensive liability insurance [9].
In summary, home health care providers must navigate an evolving legal landscape where regulatory compliance demands are tightening, telehealth flexibilities face expiration, Medicaid long-term care rules are becoming more restrictive, and CMS is intensifying enrollment oversight. Embracing technology for compliance and focusing on caregiver training and patient communication are key strategies to reduce risk and uphold patient rights in this dynamic environment.
[1] Centers for Medicare & Medicaid Services. (2022). Hospital-at-Home Model. Retrieved from https://www.cms.gov/medicare-coverage-data/hospital-at-home-model
[2] Centers for Medicare & Medicaid Services. (2022). Home Health Agency Claims Processing Manual. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/HomeHealthAgencyClaimsProcessingManual.pdf
[3] Centers for Medicare & Medicaid Services. (2022). Home Health Prospective Payment System Fact Sheet. Retrieved from https://www.cms.gov/Newsroom/Fact-Sheets/HH-PP-System-Fact-Sheet
[4] Centers for Medicare & Medicaid Services. (2022). Provider Enrollment, Re-enrollment, and Disenrollment. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Provider-Enrollment-Items/EnrollmentItems
[5] Centers for Medicare & Medicaid Services. (2022). Medicaid. Retrieved from https://www.cms.gov/Medicaid
[6] U.S. Department of Health and Human Services. (2022). HIPAA. Retrieved from https://www.hhs.gov/hipaa/
[7] Equal Employment Opportunity Commission. (2022). Home Care Providers. Retrieved from https://www.eeoc.gov/employers/industries/healthcare/home_care.cfm
[8] American Health Information Management Association. (2022). Telehealth and Compliance. Retrieved from https://www.ahima.org/telehealth-and-compliance
[9] National Association for Home Care & Hospice. (2022). Risk Management. Retrieved from https://www.nahc.org/advocacy/risk-management/
In this evolving landscape of home health care, providers are dedicating more effort to leveraging science in therapies and treatments to address medical-conditions, as part of their strategy to improve health-and-wellness for patients.
Given the growing reliance on technology and evolving regulatory compliance requirements, home health care agencies are not only relying on automation and software solutions for documentation and billing purposes but also for enhancing their educational and training opportunities for staff members regarding science-based health-and-wellness and medical-condition management.
