Home health has no single rule titled "missed visits." The Medicare Conditions of Participation never put those words in a heading. The duty is spread across the plan of care standard, the communication standards and the clinical record standard. The one place that speaks plainly about a missed visit is the surveyor guidance in the State Operations Manual.
This page is for the clinician or scheduler who just drove to a house and no one answered, or who got the call that the patient is in the ER. What do you write, and who do you tell? Every quotation below is from 42 CFR 484.60 and 484.110 on Cornell LII, or from State Operations Manual Appendix B, fetched on 2026-10-07. Anything not quoted is labelled practice, not rule.
What the Regulation Says, and What It Does Not
The regulation itself is general. These are the parts that apply.
| Paragraph | What it says | Why it matters for a missed visit |
|---|---|---|
| 42 CFR 484.60(a)(2)(iv) | The plan of care must include "The frequency and duration of visits to be made" | The ordered frequency is the baseline a missed visit is measured against |
| 42 CFR 484.60(c)(1) | The agency "must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered" | The trigger is a change that threatens outcomes, not the miss itself |
| 42 CFR 484.60(d)(1) | The agency must "Assure communication with all physicians or allowed practitioners involved in the plan of care" | Includes the physicians who give orders for the skilled services |
| 42 CFR 484.110(a)(2) | The record must include "All interventions, including medication administration, treatments, and services, and responses to those interventions" | A visit that did not happen is not an intervention, so the attempt and the follow-up need their own entry |
| 42 CFR 484.110(b) | "All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed" | The missed-visit note is a clinical record entry and is held to the same standard |
Notice what is missing. The regulation does not say how many hours you have to call the physician. It does not require a particular form. It says "promptly" and leaves the definition to the agency and, in a survey, to the surveyor.
A common mix-up: paragraph (b) of 484.60 is "Conformance with physician or allowed practitioner orders," and says "Drugs, services, and treatments are administered only as ordered." Paragraph (c) is review and revision of the plan of care. Coordination of care is paragraph (d). The prompt-alert sentence sits in (c)(1).
The Surveyor Guidance Is Where "Missed Visit" Lives
Under tag G572, the interpretive guidelines for 42 CFR 484.60(a)(1), surveyors are told:
"If the HHA misses a visit or a treatment or service as required by the plan of care, the HHA should make every attempt to reschedule the missed visit. If the visit cannot be rescheduled, the responsible physician or allowed practitioner should be notified, and the HHA should document the potential clinical impact of missed treatments or services. The HHA should advise and educate the patient on the potential impacts of missed visits."
That gives a sequence you can follow.
- Try to reschedule.
- If you cannot, notify the responsible physician or allowed practitioner.
- Document the potential clinical impact.
- Educate the patient about the impact.
The guidance says "should," not "must." It is how surveyors read the condition, not the text of the regulation. A chart that shows all four steps is the chart that answers the question before it is asked. Also note whose name is on the guidance. It says "the HHA misses a visit." That covers a clinician who could not get there and a visit that was never scheduled, not only a patient who was out.
Info
The guidance on rescheduling is also a guard against a staffing shortcut. The same tag says: "The physician or allowed practitioner should not be approached to reduce the frequency of services based solely on the availability of HHA staff." A pattern of missed visits followed by a frequency reduction is a pattern a reviewer can see. For how frequency is ordered and read, see the visit frequency guide.
When the Patient Refuses
Refusal is a different situation from a missed visit, and the guidance treats it that way. Under G572:
"If the patient or the patient's representative refuses care that could impact the patient's clinical wellbeing (such as dressing changes or essential medication) on more than one occasion, then the HHA must attempt to identify the reason for the refusal. If the HHA is unable to identify and address the reason for the refusal, then the HHA must communicate with the patient's responsible physician or allowed practitioner to discuss how to proceed with patient care."
Here the guidance does say "must." The trigger is care that could affect the patient's wellbeing and a refusal on more than one occasion. A patient who declines a single visit because of a family event is a reschedule. A patient who has declined the wound care twice is a call to the physician.
Under G460, the guidelines for the transfer and discharge standard, the agency's duty on refusals of skilled care is spelled out:
"In the case of patient refusals of skilled care, the HHA must document its communication with the physician or allowed practitioner who is responsible for the patient's home health plan of care, as well as the measures the HHA took to investigate the patient's refusal and the interventions the HHA attempted in order to obtain patient participation with the plan of care."
The same passage separates the patient who "occasionally declines a service" from one who "refuses services altogether, or who habitually declines skilled care visits," and states that "It is the patient's right to refuse services." Your job is to educate the patient on the risks, document what you did, and tell the physician. It is not to talk the patient into accepting care.
What to Write: A Missed-Visit Note
No rule gives a template. This one is practice, not rule, built so each element answers a line of the guidance above.
| Element | Example |
|---|---|
| What was scheduled | Discipline, ordered visit, date and time window |
| What happened | "No answer at door, three attempts by phone." Or: "Patient declined, states fatigue." |
| Reason, if known | In the patient's words, with who said it |
| Attempt to reschedule | When and how you tried, and the outcome |
| Potential clinical impact | The specific risk for this patient: wound not assessed, medication not set up, therapy goal delayed |
| Education | What you told the patient or caregiver about that impact |
| Who you notified | Name, role, date and time, how, and what they ordered |
| Signature | Authenticated, dated and timed under 484.110(b) |
Write the clinical impact as something particular to the patient. "Missed visit" tells a reviewer nothing. "Wound check not done, patient has a stage 3 sacral pressure injury with a dressing due for change" tells them why the physician needed to know.
Tip
Practice, not rule: pick an internal deadline for physician notification and write it in the policy, so "promptly" means the same thing to every clinician in your agency. The regulation does not set a number. Whatever deadline you choose is your convention, and a surveyor will hold you to your own policy.
Common Situations
Patient not home. Reschedule attempts, call the caregiver or emergency contact whose contact information is already in the record under 484.110(a)(4), document the attempts. If the visit cannot be rescheduled, notify the physician.
Patient refuses once. Educate, document the reason, offer another time. Whether the physician needs a call depends on whether the care could affect clinical wellbeing and on your agency's policy.
Patient refuses more than once, or refuses essential care. Find the reason. If you cannot resolve it, communicate with the responsible physician or allowed practitioner. This is the "must" in G572.
Clinician is sick, or the schedule collapsed. Same sequence: reschedule, then notify if you cannot. Do not frame it as a patient decision. The guidance covers "the HHA misses a visit."
Patient is in the ER or admitted to the hospital. The visit was not missed in the same sense, but the record needs to say what happened. For an unplanned transfer, 42 CFR 484.110(a)(6)(iii) requires "A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer." What happens on return is a separate set of rules, covered in the resumption of care guide.
Visit missed on a supervisory schedule. Supervisory visits have their own timing. See supervisory visit requirements.
For Agencies: What a Survey Will Look For
A surveyor reading a chart with a gap in visits is asking three questions. Was there an attempt to reschedule? Was the physician told when it could not be rescheduled? Was the clinical impact written down? You can answer them in the chart or you cannot.
Two points for agency leaders. First, the guidance says staffing is not a reason to go to the physician for a lower frequency. Second, a high rate of missed visits is a measure you may want to watch internally. That is a management choice, not a CMS threshold, and no rule sets a number at which it becomes a deficiency. For how quality performance is scored, see the HHVBP annual performance report.
Key Takeaways
- The Conditions of Participation have no missed-visit heading. The duty comes from 484.60, 484.110 and the surveyor guidance at G572.
- Surveyor guidance for a missed visit: try to reschedule, notify the responsible physician or allowed practitioner if you cannot, document the potential clinical impact, and educate the patient.
- Repeated refusal of care that could affect wellbeing requires finding the reason and, if it is not resolved, communicating with the physician.
- The regulation says "promptly," not a number of hours. Any hour count is agency practice, not rule.
- Never ask the physician to cut frequency because of staff availability. Write the note so another clinician could see what happened and why.
Frequently asked questions
Does the Medicare CoP have a missed visit rule?
Not under that name. The regulation never uses the phrase in a heading. The rule comes from the plan of care and communication standards in 42 CFR 484.60, the clinical record standard in 42 CFR 484.110, and the State Operations Manual guidance that surveyors use for tag G572.
Do I have to notify the physician every time a visit is missed?
The surveyor guidance says that if a missed visit cannot be rescheduled, the responsible physician or allowed practitioner should be notified and the potential clinical impact documented. Separately, the regulation requires prompt alerts for changes in condition or needs that suggest outcomes are not being achieved.
What do I write when a patient refuses a visit?
Record the refusal, the reason you learned or tried to learn, the education you gave about the risks, what you attempted to get the patient to take part, and your communication with the responsible physician or allowed practitioner. Surveyor guidance expects exactly those pieces for refusals of skilled care.
Can I ask the physician to cut the frequency because we are short-staffed?
No. Surveyor guidance states that the physician or allowed practitioner should not be approached to reduce the frequency of services based solely on the availability of agency staff. A frequency change needs a clinical reason.
What if the patient was admitted to the hospital or the ER?
The visit was not missed by the clinician, but the record still has to show what happened. For an unplanned transfer, the regulation requires a transfer summary sent within 2 business days of the agency becoming aware, if the patient is still receiving care in a facility.
Sources
- 42 CFR 484.60: plan of care (a), conformance with orders (b), review and revision (c), coordination of care (d).
- 42 CFR 484.110: clinical records, contents (a), authentication (b).
- CMS, State Operations Manual, Appendix B, Guidance to Surveyors: Home Health Agencies: tags G572, G460, G590, G1014, G1024 (Rev. 219).
- Related on this site: home health visit frequency guide, supervisory visit requirements, resumption of care, HHVBP annual performance report.