Home Health Medicare & State Licensure Forms & Resources

An entity operating as a certified/licensed home health agency must offer two skilled services on an intermittent basis, one of which must be skilled nursing.

Home Health Aide Competency Evaluation - Call our office at 573/751-6336 to obtain a copy.

How to Apply

Federal Interpretive Guidelines

Letter of Intent for State Licensure and/or Medicare Certification

Application for Home Health Agency License

State Disclosure of Ownership and Control Interest Statement

Office for Civil Rights Packet Information

Assurance of Compliance (Title VI or Civil Rights Act)

Health Insurance Benefit Agreement

197.400 - 197.478 RSMo Home Health Agencies

19 CSR 30-26.010 Home Health Licensure Rule

42 CFR 484.10 - 484.20 Conditions of Participation: Home Health

Alzheimer's and Dementia Specific Training - 660.050

Interpretive Guidelines - Home Health Agencies (State Operations Manual-Appendix B)

Patient Rights (42 CFR 484.10)

Criminal Background - 660.317

Family Care Safety Registry

Advance Directive Information - 42 CFR 489.100-489.104

MO Law Regarding a Patient's Right to Make Health Care Treatment Decisions

Pharmacy Rule

Hepatitis B - 29 CFR 1910.1030(f)(1), (i)(ii),(ii)(A),(2)(iv)

OASIS and HAVEN Help Resources

Home Health Advance Beneficiary Notice (HHABN)