Required vs recommended home care policies
By Scott McKenzie, founder of Home Care Agency Blueprint · Updated
A policy is required when a rule that applies to your agency says so: usually your state’s licensing rules, sometimes a payer contract or a federal rule. Everything else in your manual is good practice. Find your state’s list first, check which federal rules apply to you with counsel, and label each policy by where it comes from.
Start with your state’s list
Your state’s home care licensing rules are the main source of required policies. Read the rules for your license type, and look for any guidance, checklists or inspection tools your licensing agency publishes. When a rule names a policy, cite the rule section in your policy so you can find it again. homecarelicenseguide.com, also published by Home Care Agency Blueprint, links to each state’s licensing sources.
Payers and contracts can add requirements
If you contract with a Medicaid waiver program, a managed care plan or another payer, the provider agreement may require written policies of its own. Read each agreement before you sign it, and add what it requires to your manual. becomemedicaidprovider.com, also published by Home Care Agency Blueprint, covers becoming a Medicaid provider.
Federal rules that may apply, depending on your agency
| Rule | Who it covers | What to check |
|---|---|---|
| HIPAA Privacy and Security Rules | Covered entities and their business associates. HHS says a health care provider is a covered entity only if it transmits health information electronically in connection with a transaction for which HHS has adopted a standard. | Decide with counsel whether you are a covered entity. HHS OCR, HIPAA covered entities and business associates. |
| Federal civil rights laws, including Section 1557 | Health programs and activities that receive federal financial assistance from HHS, which can include Medicaid payments. | If you receive Medicaid or other federal funds, check with counsel. HHS OCR, Civil rights laws for providers (incl. Section 1557). |
| OSHA standards, including bloodborne pathogens | Employers. The bloodborne pathogens standard applies to occupational exposure to blood or other potentially infectious materials. | Check whether your workers have occupational exposure, and whether your state runs its own OSHA plan. OSHA, Bloodborne pathogens standard (29 CFR 1910.1030). |
| Federal wage and hour rules | Employers of home care workers. The rules for home care workers are changing. | Check the current DOL status and your state’s wage laws. DOL WHD, FLSA and direct care workers. |
| CMS emergency preparedness rule | Certain Medicare and Medicaid participating provider and supplier types, including Medicare-certified home health agencies. | Check whether it applies to you. CMS, Emergency Preparedness Rule. |
Skilled or Medicare-certified home health has separate federal rules (42 CFR Part 484) on top of a state home health license. This site covers non-medical home care.
Recommended: good practice
Some sections belong in a manual even when no rule names them, because they make the agency run the same way every day: a policy approval process, a version log, a review date on every policy, and a clear place where caregivers can find the manual. In the outline, these are marked as your own planning.
How to sort each policy
- Does your state’s licensing rule name it? Cite the rule section.
- Does a payer contract or provider agreement require it? Note the contract.
- Does a federal rule apply to your agency? Decide with counsel, and cite the rule.
- If none of these, label it good practice, and keep it only if your agency will follow it.
A template is a starting draft. A purchased or downloaded manual can save typing, but it may describe another state’s rules, services you do not offer or steps your staff do not follow. Rewrite each policy for how your agency actually works, date it, train staff on it, and check it against your state’s rules.
Your state sets the details. Your state’s licensing rules decide which written policies a home care agency needs and what they cover. This site does not list state requirements. Check with your state licensing agency; homecarelicenseguide.com, also published by Home Care Agency Blueprint, collects each state’s licensing sources. Not legal advice. Check with counsel and your state licensing agency.
What to do next
Frequently asked questions
Is a policy required just because a template includes it?
No. A template may include policies from another state or for services you do not offer. A policy is required when a rule that applies to your agency says so.
Does my state publish a checklist?
Check your licensing agency’s website for any guidance, checklists or inspection tools it publishes, or see homecarelicenseguide.com, also published by Home Care Agency Blueprint.
Want to talk through your options?
A free 15-minute clarity call with Home Care Agency Blueprint. It helps people start home care agencies, so expect that perspective. You do not need a finished manual first.
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