42 CFR § 484.60
Condition of participation: Care planning, coordination of services, and quality of care
See your compliance status for this section
3-minute free audit. CFR-cited gap report. No signup.
What does 42 CFR § 484.60 require?
42 CFR 484.60 is the Plan of Care (POC) Condition of Participation. Every HHA patient must have a written, individualized POC developed with the patient and the physician (or allowed practitioner, NP, CNS, PA). The POC must be established BEFORE care begins and signed by the physician within a reasonable timeframe (typically interpreted as before billing). The POC covers diagnoses, services, frequency, duration, medications, supplies, safety, discharge plan: comprehensive. Updated when patient condition changes. Care must be delivered per the POC. Common deficiencies: care delivered without a signed POC, POC not individualized (cut-and-paste from another patient), POC not updated when condition changes, services delivered outside POC scope.
Regulation text (summary)
Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, rehabilitative, and social needs can be met adequately in the patient's place of residence. Each patient must receive an individualized written plan of care, developed in partnership with the patient and physician (or allowed practitioner). The plan of care must include all pertinent diagnoses, the patient's mental, psychosocial, and cognitive status, types of services, supplies, and equipment required, the frequency and duration of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, all medications and treatments, safety measures, instructions for timely discharge or referral, and any additional items the HHA or physician determines necessary.
Read full regulation at eCFR.govWho must comply with 42 CFR § 484.60?
All Medicare/Medicaid certified HHAs. The CoP applies to every patient, including private-pay if the HHA is certified.
What happens if you violate 42 CFR § 484.60?
Standard or condition-level CMS deficiency. Civil money penalties under 42 CFR 488.845 run from $500 to $10,000 per day or $1,000 to $10,000 per instance, before the annual adjustment under 45 CFR part 102. Combined with 484.55 (comprehensive assessment) deficiencies, which often co-occur, exposure compounds across the survey. State licensure parallel consequences.
Penalty: Civil money penalties for a home health agency run from $500 to $10,000 per day of noncompliance (upper range $8,500 to $10,000 for immediate jeopardy, middle range $1,500 to $8,500, lower range $500 to $4,000) or $1,000 to $10,000 per instance, as stated in the regulation and before the annual adjustment under 45 CFR part 102. 42 CFR 488.845(b)
Penalty schedule read from the cited source on 2026-09-09.
How to comply (implementation checklist)
- 1Acceptance criteria documented for every patient (medical, nursing, rehab, social needs met at home).
- 2Plan of care established before first care visit.
- 3POC includes all required elements (diagnoses, services, frequency, duration, medications, supplies, safety, discharge).
- 4POC individualized to the patient's comprehensive assessment.
- 5Physician/allowed practitioner certification obtained within HHA's written policy timeframe.
- 6Coordination of services across disciplines documented.
- 7POC updated when patient condition changes significantly.
- 8Verbal orders documented immediately + converted to signed orders.
- 9Audit POCs monthly for boilerplate / individualization gaps.
- 10Train clinicians on POC development from OASIS assessment data.
Common misinterpretations
- Misinterpretation: 'The POC can be signed after we start visits.' Reality: The POC must be ESTABLISHED before care begins per 42 CFR 484.60(a). Physician signature can come slightly later (typically before billing), but the WRITTEN POC must exist before the first care visit.
- Misinterpretation: 'Templates are fine.' Reality: 42 CFR 484.60(a)(2) requires an INDIVIDUALIZED plan reflecting the comprehensive assessment. Templates that don't account for patient-specific needs are citable. Surveyors compare POCs across patients to look for boilerplate language.
- Misinterpretation: 'NPs can't sign HHA POCs.' Reality: The 2020 amendment under 42 CFR 484.60 permits 'allowed practitioners' (NPs, CNSs, and PAs) to certify HHA care plans, in addition to physicians. This was a major operational change for many HHAs.
- Misinterpretation: 'Verbal orders are enough.' Reality: Verbal orders must be documented immediately and converted to a signed order within the timeframe established by HHA policy (typically 5-7 days). Verbal-only orders without written follow-up are citable.
How FileFlo handles 42 CFR § 484.60
FileFlo files the records this section calls for, reads the dates off them, and tracks each one against its renewal. Where a record this section needs is missing or out of date, the gap is named with the citation in your audit binder.
Run free audit covering this section →Already evaluating? Start a 14-day free trial →
Frequently asked questions
Who can certify a home health Plan of Care?▾
Physicians have always been able to certify. Since the 2020 amendment under 42 CFR 484.60, 'allowed practitioners' can also certify HHA POCs: Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs). This was a major operational change for many HHAs and reduced delays.
When must the POC be established?▾
BEFORE care begins. Physician signature can come slightly later (typically before billing), but the written POC must exist before the first care visit. Care delivered without a written POC is a serious citation.
What must be in the POC?▾
Per 42 CFR 484.60(a)(2): all pertinent diagnoses; patient's mental, psychosocial, and cognitive status; types of services, supplies, and equipment; frequency and duration of visits; prognosis; rehabilitation potential; functional limitations; activities permitted; nutritional requirements; all medications and treatments; safety measures; instructions for timely discharge or referral; additional items.
How often must the POC be updated?▾
When the patient's condition changes significantly, OR at recertification (every 60 days for Medicare), OR when interventions change. Continuous-care patients require POC updates at least every 60 days under the recertification cycle.
Can the POC be electronic?▾
Yes. Electronic POCs are fully acceptable as long as they capture all required elements, are accessible to clinicians during care, and the physician/allowed practitioner certification is documented (electronic signature acceptable).
What happens if my POC isn't individualized?▾
Surveyor deficiency. Common pattern: HHAs use POC templates that don't account for patient-specific needs, leading to copy-paste boilerplate that contradicts the OASIS assessment. Surveyors compare POCs across patients and cite when patterns suggest non-individualization.
Related regulations
Author
Chad Griffith
Founder + CEO, FileFlo · Defense + Aviation + healthcare operations background
LinkedInSources + reviewer
Primary source: eCFR.gov: 42 CFR § 484.60
Reviewed by Chad Griffith (Founder + CEO, FileFlo) on