Accreditation (ACHC, CHAP, TJC)
Accreditation is a voluntary evaluation in which a CMS-approved accrediting organization certifies that a home health agency meets standards that meet or exceed the Medicare Conditions of Participation. For home health, the three accreditors with CMS deeming authority are the Accreditation Commission for Health Care (ACHC), Community Health Accreditation Partner (CHAP), and The Joint Commission (TJC). Accredited agencies with deemed status are surveyed by their accreditor instead of the state for routine certification purposes.
The three CMS-approved accreditors for home health
ACHC, CHAP, and The Joint Commission each hold CMS deeming authority for home health, meaning CMS has approved their standards and survey processes as at least equivalent to the federal requirements. All three survey on roughly a three-year cycle with unannounced on-site visits. They differ in style and emphasis: standards structure, surveyor approach, education and support resources, and pricing vary, and many agencies choose based on which accreditor their other service lines (hospice, private duty, DMEPOS) already use. From CMS's perspective the three are interchangeable for deemed status; from an operator's perspective the fit with your organization matters.
Deeming authority and what it changes
When an agency is accredited under a CMS-approved program and elects deemed status, the accreditor's survey substitutes for the routine state recertification survey. The state survey agency still investigates complaints, and CMS can order validation surveys to check the accreditor's work. Enforcement does not soften: if an accreditation survey identifies condition-level noncompliance, the finding flows into the same CMS enforcement process, including termination timelines and alternative sanctions. Deemed status changes who shows up for the routine survey, not the rules being enforced or the consequences of failing them.
Why agencies pursue accreditation
Since Medicare certification is available through the state survey path at no charge, accreditation is a business decision as much as a compliance one. Common reasons agencies pay for it:
- Managed care and Medicare Advantage networks often require accreditation for contracting
- Some states require or strongly favor accreditation for licensure or new agencies
- Referral sources and health systems treat it as a credibility signal
- Accreditor standards and education impose operational discipline beyond the CoP minimum
- Predictable survey cycles and consultative resources help multi-site organizations standardize
For agencies pursuing growth through payer contracts, accreditation is frequently the price of entry.
What the accreditation cycle looks like
The process starts with an application and a self-assessment against the accreditor's standards, followed by policy review and an unannounced initial survey that includes home visits and record review. Deficiencies require a corrective action plan, and accreditation is typically granted for a three-year term with interim reporting requirements and the possibility of unannounced follow-up visits. Renewal surveys repeat the cycle. Budget for direct fees plus the internal effort: the agencies that get the most value treat accreditation standards as their operating manual year-round rather than a triennial scramble.
Frequently asked questions
Is accreditation required to bill Medicare?
No. An agency can be certified through the state survey process without any accreditor. Accreditation becomes practically necessary when states, Medicare Advantage plans, or managed care networks require it, which is increasingly common in competitive markets.
Which accreditor should a home health agency choose?
All three (ACHC, CHAP, TJC) confer the same deemed status with CMS. Compare standards fit, surveyor style, education resources, pricing, and which accreditor covers your other business lines. Talking to similarly sized agencies about their survey experience is usually more informative than marketing materials.
Can an accredited agency still be surveyed by the state?
Yes. Deemed status only replaces the routine recertification survey. The state survey agency still investigates complaints against accredited agencies, and CMS can conduct validation surveys to verify the accreditor's findings. Serious findings from any of these routes carry full enforcement consequences.