Essential Medicare Home Health and Hospice Checklists for Survey Readiness

CMS survey readiness for home health and hospice agencies is centered on compliance with the Conditions of Participation (CoPs). Surveyors use specific "task" protocols to evaluate care quality through home visits, record reviews, and staff interviews.

Below are the primary checklists and required materials for both home health and hospice agencies.

1. Administrative & Logistics Checklist

These items should be organized and ready to present within the first 30 to 60 minutes of a surveyor's arrival:

· Agency Identification: Current State License, accreditation certificates, and CLIA Certificate of Waiver (if applicable).

· Leadership Structure: An up-to-date organizational chart including designated alternates for key roles.

· Service Area: A map or list of all geographical areas served, including branch locations.

· Meeting Minutes: Governing Body and QAPI committee minutes for the last 12 months.

· Contracts: Current agreements for all contracted services (e.g., pharmacy, DME, therapy).

2. Required Patient Reports (Last 12 Months)

Surveyors will use these lists to select their sample for review:

· Census Reports: Current active patient census including start-of-care dates, diagnoses, and assigned disciplines.

· Unduplicated Admissions: Total number of patients admitted over the past year.

· Discharge/Transfer Lists: Detailed listing of discharges, transfers, and revocations (for hospice).

· Visit Schedules: A schedule of all planned patient visits for the duration of the survey.

3. Clinical & Personnel File Audit Items

· Personnel Files: Must include current professional licenses, orientation checklists, annual competencies, and background checks.

· Education: Proof of 12 hours of annual continuing education for aides.

· Infection Control: A current Infection Control Plan and logs tracking infections for both patients and staff.

· Emergency Preparedness: Documentation of an all-hazards risk assessment and evidence of annual testing/drills.

4. Hospice-Specific Survey Materials

· Bereavement Records: Access to records for expired patients from the last year.

· Volunteer Logs: Documentation of volunteer hours and recruitment efforts.

· Election Forms: Signed hospice benefit election forms for the selected sample.

5. Home Health-Specific Survey Materials

· OASIS Reports: Most recent Agency Patient Related Characteristics and Error Summary reports.

· Plan of Care (Form 485): Evidence of physician-signed verbal orders and timely updates

Creating a survey readiness list is only the first step. SOMEONE must be responsible for each step. If everyone is responsible, no one is responsible! Assign appropriate individuals to survey each element and ensure all are accurate and timely. These reports should be provided monthly at the managers' meeting, and any discrepancies should be addressed for correction.

If you are having difficulty making sure you are always ready for a survey, contact Kenyon HomeCare Consulting for assistance. We can complete a virtual review or on-site mock review and provide a report of findings to ensure you are always prepared for a survey visit.

For assistance, contact Kenyon HomeCare Consulting at 206-721-5091 or email gkenyon@kenyonhcc.com.