Home health certification manual incorporates allowed practitioners
Oct 4, 2026 edition · GC-2026-0148 · Published 2026-10-04 · Version 2 · Final
CMS’s November manual update incorporates existing allowed-practitioner home-health certification authority and preserves eligibility-documentation requirements.
What happened
CMS’s September 30 Transmittal 13972, CR 14627, updates the Program Integrity Manual’s home-health sections effective and implementing November 2. It reflects CARES Act authority from March 2020 allowing nurse practitioners, clinical nurse specialists and physician assistants to order and certify eligibility and establish a plan of care. Contractors must accept qualifying documentation from these allowed practitioners. The manual update therefore aligns review instructions with existing authority, rather than creating a new 2026 scope-of-practice expansion or making every practitioner’s documentation sufficient by title alone.
Certification still needs support for homebound status, skilled care, the plan of care, supervision and a qualifying face-to-face encounter related to the primary home-health reason within 90 days before or 30 days after start of care. The manual requires supporting certifier or qualifying facility records; HHA-generated material alone is insufficient unless appropriately incorporated and signed off. Recertification does not cure an unsupported initial certification, and applicable financial-relationship restrictions remain. As of October 4, agencies should prepare the November instruction update by validating credentials and record flow while retaining the remaining eligibility and periodic recertification controls.
Scope and timing
- Authority status
- Final
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
- Affected functions
- Clinical Operations, Compliance, Provider Enrollment
- Responsible owner
- Clinical Operations
- Recorded date
- 2026-11-02
- Date type
- effective
Why it matters
Admission and review processes must accept valid allowed-practitioner records without weakening the evidence needed to support payment.
Recommended action
Validate templates, practitioner credentials, face-to-face timing and supporting-record incorporation against the revised manual, preserving financial-relationship and initial-certification requirements.
Implementation playbook
- Validate certification templates, practitioner credentials and supporting medical records against the revised manual while preserving all other eligibility requirements. Clinical Operations · Due 2026-11-02
- Record the applicability assessment and validate the affected workflow with its operational owner. This is an internal review target, not an additional statutory deadline. Compliance · Due 2026-10-12
Sources
- CMS Transmittal R13972PIOfficial · Centers for Medicare & Medicaid Services · 2026-09-30 · Source review 2026-10-04
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
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