Conditions of Participation · 42 CFR Part 484
§484.75 Condition of participation: Skilled professional services.
The regulation text and CMS’s interpretive guidelines for every survey tag under this condition, quoted from the State Operations Manual, Appendix B (Rev. 245).
CMS lists these tags as Level 1 standards (SOM Appendix B, Part I.C, Table 1):
A partial extended survey is conducted when noncompliance is identified in any Level 1 standard.
§484.75 Condition of participation: Skilled professional services.
On the 2567: Skilled Professional Services
Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care.
CMS’s guidance for this tag
Interpretive Guidelines § 484.75
The manner and degree of noncompliance identified in relation to the standard level tags for §484.75 may result in substantial noncompliance with this CoP, requiring citation at the condition level.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(a) Standard: Provision of services by skilled professionals.
On the 2567: Services By Skilled Professionals
Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(b) Standard: Responsibilities of skilled professionals.
On the 2567: Responsibilities Of Skilled Professionals
Skilled professionals must assume responsibility for, but not be restricted to, the following:
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Interdisciplinary Assessment Of The Patient
(1) Ongoing interdisciplinary assessment of the patient;
CMS’s guidance for this tag
Interpretive Guidelines §484.75(b)(1)
The term “interdisciplinary” refers to an approach to healthcare that includes a range of health service workers.
“Ongoing interdisciplinary assessment” is the continual involvement of all skilled professional staff involved in a patient’s plan of care from the initial assessment through discharge, which should include periodic discussions among the team regarding the patient’s health status and recommendations for the plan of care.
An interdisciplinary approach recognizes the contributions of various health care disciplines (MDs, RNs, Licensed Practical/Vocational Nurses (LPN/LVN), PT, OT, SLP, Master of Social Work (MSW), HH aides) and their interactions with each other to meet the patient's needs.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Development And Evaluation Of Plan Of Care
(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s);
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Provide Services In The Plan Of Care
(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care;
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Patient, Caregiver, And Family Counseling
(4) Patient, caregiver, and family counseling;
CMS’s guidance for this tag
Survey Procedures §484.75(b)(4)
Home visit observations with direct care observation and patient interview should assist in determining compliance with this requirement. The clinical record should reflect the education and counseling provided by skilled professionals to the patient, caregiver, and family (see also §484.75(b)(5)).
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Patient And Caregiver Education
(5) Patient and caregiver education;
CMS’s guidance for this tag
Survey Procedures §484.75(b)(5)
Home visit observations with direct care observation and patient interview should assist in determining compliance with this requirement. The clinical record should reflect the education and counseling provided by skilled professionals to the patient, caregiver, and family (see also §484.75(b)(4)).
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Preparing Clinical Notes
(6) Preparing clinical notes;
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Communication With Physicians
(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care;
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Participate In The Hha'S Qapi Program;
(8) Participation in the HHA’s QAPI program; and
CMS’s guidance for this tag
Interpretive Guidelines §484.75(b)(8)
All skilled professional staff must provide input into and participate in the implementation of the HHA’s QAPI program for the QAPI program to be effective. Every HHA skilled professional, regardless of whether the skilled professional is a direct employee or contractor of the HHA, is expected to contribute to all phases of the QAPI program. These contributions may include: identification of problem areas; recommendations to address problem areas; data collection; attendance at periodic QAPI meetings; and participation in performance improvement projects.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
[§484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:]
On the 2567: Participate In Hha-Sponsored In-Service
(9) Participation in HHA-sponsored in-service training.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(c) Standard: Supervision of skilled professional assistants.
On the 2567: Supervise Skilled Professional Assistants
- The CFR reads: “(c) Supervision of skilled professional assistants.”
Logicly’s note, not CMS text
the manual labels this paragraph a Standard; the CFR heading does not
CMS’s guidance for this tag
Interpretive Guidelines §484.75(c)
Documentation in the clinical record should show how communication and oversight exist between the skilled professional and assistant regarding the patient’s status, the patient’s response to services furnished by the assistant, and the effectiveness of any written instructions provided by the skilled professional to the assistant.
Any specific written instructions by skilled professionals to assistants are based on treatments prescribed in the patient’s plan of care, patient assessments by the skilled professional, and accepted standards of professional practice. The skilled professional must periodically evaluate the effectiveness of the services furnished by the assistant to ensure the patient’s needs are met.
Survey Procedures §484.75(c)
Documentation in the clinical record should demonstrate evidence that the skilled professionals supervise professional assistants as per HHA policy. Supervision of the skilled assistants must be conducted by the same discipline as the skilled professional that developed the assistant’s instructions. Look for evidence in the clinical record that the skilled professional remains active in the ongoing plan of care through periodic supervisory follow-up. Review clinical notes to verify that professional assistants adhere to the instructions established by the skilled professional and that they document the treatment and patient response to the treatment.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(c)(1)
On the 2567: Nursing Services Supervised By Rn
§484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k).
CMS’s guidance for this tag
Interpretive Guidelines §484.75(c)(1)
The HHA should identify a registered nurse (RN) to supervise the care provided by licensed practical/vocational nurses (LPN/LVNs). §484.115(k) requires the RN be a graduate of an approved school of professional nursing who is licensed in the state where practicing.
The identified RN must in turn monitor and evaluate LPN/LVN performance in the provision of services, provision of treatments, patient education, communication with the RN, and data collection regarding the patient’s status and health needs (as delegated by the RN). Only a registered nurse may perform comprehensive assessment, evaluations, care planning and discharge planning.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(c)(2)
On the 2567: Rehab Services Supervised By Pt, Ot
§484.75(c)(2) Rehabilitative therapy services are provided under the supervision of an occupational therapist or physical therapist that meets the requirements of §484.115(f) or (h), respectively.
CMS’s guidance for this tag
Interpretive Guidelines §484.75(c)(2)
An assistant must be supervised by a skilled therapy professional for the assistant’s respective therapy type. For example, only a physical therapist may supervise a physical therapist assistant and only an occupational therapist may supervise an occupational therapy assistant. The applicable therapist should monitor and evaluate the therapy assistant’s performance regarding provision of treatments, patient education, communication with the therapist, and data collection regarding the patient’s status and health needs (as delegated by the therapist). Only the skilled therapist may perform comprehensive assessments, patient evaluations, care planning and discharge planning.
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(c)(3)
On the 2567: Medical Social Services Supervised By Msw
§484.75(c)(3) Medical social services are provided under the supervision of a social worker that meets the requirements of §484.115(m).
CMS’s guidance for this tag
Interpretive Guidelines §484.75(c)(3)
Any social service provided by a social work assistant must be supervised by a social worker who has a master’s degree or doctoral degree from a school of social work accredited by the Council on Social Work Education and has 1 year of social work experience in a health care
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
Current CFR text, 42 CFR 484.75 as revised 2025-10-01 (govinfo)
§ 484.75 Condition of participation: Skilled professional services.
Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in § 409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in § 409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care.
(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under § 484.115 and who practice according to the HHA's policies and procedures.
(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following:
(1) Ongoing interdisciplinary assessment of the patient;
(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s);
(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care;
(4) Patient, caregiver, and family counseling;
(5) Patient and caregiver education;
(6) Preparing clinical notes;
(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care;
(8) Participation in the HHA's QAPI program; and
(9) Participation in HHA-sponsored in-service training.
(c) Supervision of skilled professional assistants. (1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of § 484.115(k).
(2) Rehabilitative therapy services are provided under the supervision of an occupational therapist or physical therapist that meets the requirements of § 484.115(f) or (h), respectively.
(3) Medical social services are provided under the supervision of a social worker that meets the requirements of § 484.115(m).
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Source: State Operations Manual, Appendix B - Guidance to Surveyors: Home Health Agencies (Rev. 245, issued 08-05-26), text extracted from the PDF with pdftotext, retrieved 2026-10-09, and 42 CFR Part 484, annual edition revised as of October 1, 2025 (govinfo XML granules). Works of the US Government are in the public domain.
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