Acceptance-to-Service Policy & Referral Review Checklist
CMS now expects Medicare-certified home health agencies to maintain and consistently apply an Acceptance-to-Service Policy when evaluating every prospective patient. Having a policy in the manual is not enough—the agency must also demonstrate that referral decisions reflect the patient’s anticipated needs and the agency’s actual capacity to provide care.
The C&C Strategic Consulting, LLC Acceptance-to-Service Policy and Referral Review Checklist provide agencies with a practical framework aligned with 42 CFR §484.105(i) and CMS Appendix B guidance for G990 and G992.
 
This package includes:
An editable Acceptance-to-Service Policy
The four required G990 capacity considerations
Requirements for publicly communicating services and service limitations under G992
Defined Accept, Hold/Pending, and Decline pathways
A ready-to-use referral review checklist
Documentation and referral-source communication expectations
Annual review, monitoring, and audit guidance
This resource helps intake teams, clinical reviewers, and agency leadership make consistent, supportable referral decisions while identifying documentation, diagnosis, staffing, and competency concerns before they become admission problems.
The policy is provided in an editable format so each agency can add its name, responsible personnel, internal timeframes, services, and operational requirements.
 
Recommended for:
Medicare-certified home health agencies
Administrators and Directors of Nursing
Intake and referral teams
Clinical managers and QA personnel
Agencies preparing for CHAP, ACHC, Joint Commission, or state survey activity
 
Important: This resource is intended as an operational and educational template. Each agency remains responsible for reviewing and customizing the materials according to its services, state requirements, accrediting organization, payer contracts, and internal operations.