ACHC Accreditation Preparation: A Step-by-Step Guide for New Home Health and Hospice Agencies

ACHC accreditation preparation is the work a new home health agency or hospice does before an Accreditation Commission for Health Care (ACHC) surveyor arrives. Done early, the survey simply confirms how you already operate. Done late, it usually means a plan of correction and more waiting before you can bill Medicare. This guide covers what ACHC accreditation gives you, the Medicare rules you must meet first, the survey process step by step, and a practical readiness checklist.

What ACHC accreditation means for a new agency

ACHC is one of three accrediting organizations that CMS has approved for both home health and hospice, alongside CHAP and The Joint Commission. ACHC has held CMS deeming authority for home health since 2006 and for hospice since 2009. CMS has since renewed both approvals, through February 2031 for home health and November 2031 for hospice.

Deemed status means CMS accepts an approved accreditor’s survey instead of a state survey agency’s, as long as you meet every other Medicare participation requirement (42 CFR 488.1). ACHC also accredits private duty home care through its Home Care program. However, that program carries no Medicare deeming, because non-medical home care is not a Medicare benefit.

What you need before the ACHC survey

Good ACHC accreditation preparation starts with the federal prerequisites, because the survey can’t help you if these are missing:

• A state license, where your state requires one. Federal rules say a home health agency must be licensed if state or local law licenses home health agencies (42 CFR 484.100), and hospices follow the same rule. Our state licensing guides cover each state we serve.
• An approved Medicare enrollment application. According to ACHC’s FAQs, an agency seeking initial Medicare certification needs an approved CMS-855A before accreditation begins.
• Initial reserve operating funds (home health only). Under 42 CFR 489.28, a new home health agency must show enough funds to operate for its first three months after billing privileges, not counting Medicare receivables. At least half of those funds must be non-borrowed.
• Patients on service. CMS survey guidance expects a new home health agency to have cared for at least 10 skilled patients, with at least 7 receiving skilled care at the initial survey. Those patients don’t have to be Medicare patients. For a new hospice, the guidance is at least 5 patients served and 3 active. Agencies in medically underserved areas may qualify for lower numbers (CMS State Operations Manual, Appendix B).

Why the 2026 moratorium changes your order of steps

On May 13, 2026, CMS placed a six-month nationwide moratorium on new Medicare enrollment for home health agencies and hospices (Federal Register notice). CMS guidance makes two points that matter here. First, CMS denies 855A applications filed during the moratorium. Second, accreditation by an approved accreditor can’t serve as the basis for Medicare participation while the moratorium lasts (CMS QSO-26-11).

The moratorium is scheduled to end around November 13, 2026, but CMS can extend it in six-month steps. As of October 21, 2026, CMS had published no extension or end notice. That makes the wait the best time for ACHC accreditation preparation. The practical sequence is: get licensed, build your census and compliant operations now, file the 855A when enrollment reopens, then schedule the survey. We explain the timing in more detail in our article on the end of the Medicare enrollment freeze.

The ACHC accreditation process, step by step

ACHC publishes its process on its program pages. Here is how it works for a home health agency or hospice seeking deemed status:

1. Connect and register. You speak with ACHC’s team and set up an account on its customer portal.
2. Apply with a deposit. You submit the application and deposit. ACHC prices each program by quote. It describes the fee as a single inclusive fee, with no annual fees and no separate surveyor expenses.
3. Verification and scheduling. An ACHC Account Advisor checks your file and schedules the survey. ACHC says the survey generally takes place less than 90 days after you submit all required information.
4. The survey. Deemed status surveys are unannounced, and there is usually one surveyor. Expect an opening conference, observation, staff interviews, record and document review, and a closing conference.
5. Report and plan of correction. ACHC issues the final survey report within 10 business days of the last survey day. If the surveyor cites deficiencies, you submit a plan of correction. ACHC’s current home health page allows 30 days from the final report, while older ACHC guidance allowed 10 calendar days, so confirm the deadline with your Account Advisor.
6. Decision. ACHC’s Review Committee decides on accreditation, and the decision letter follows within 5 business days.
7. Staying accredited. ACHC surveys on a three-year cycle, and federal rules require an unannounced resurvey within 36 months (42 CFR 488.5). ACHC recommends starting renewal six months before your accreditation expires.

Where new agencies most often fall short

ACHC publishes its most common survey findings, and they point to documentation more than anything else. In October 2025, ACHC reported that all five of its top home health deficiencies came from its Provision of Care and Record Management section, mostly documentation gaps. Its survey handouts also name home health aide services (42 CFR 484.80) as the most-cited condition-level deficiency for home health. For hospice, the equivalent is hospice aide and homemaker services (42 CFR 418.76).

In other words, surveyors read your records closely, so ACHC accreditation preparation should start with your records. Written aide instructions from the registered nurse, care that follows the plan of care, and complete clinical records are where new agencies most often get caught.

Your ACHC accreditation preparation checklist

Use this list to check your agency’s readiness before you schedule anything:

• Policies and procedures written to the Medicare Conditions of Participation (42 CFR Part 484 for home health, Part 418 for hospice), and staff who actually follow them. Our policy and procedure manuals are built for this.
• Personnel files with licenses, background checks, orientation and competency records for every clinician and aide.
• Assessment and care planning workflows, including the registered nurse’s written aide instructions and current plans of care.
• A working quality assessment and performance improvement (QAPI) program that uses real data.
• Infection prevention and emergency preparedness plans that staff have been trained on.
• Patient rights notices and a working complaint process.
• Regular mock record audits against ACHC’s standards. ACHC also offers workbooks, webinars and workshops through its education program.
• Census tracking toward the 10 and 7 thresholds for home health, or 5 and 3 for hospice.
• For home health, bank statements and a bank attestation that prove your initial reserve operating funds.

How long does ACHC accreditation preparation take?

There is no single answer. ACHC’s own target is a survey generally within 90 days once it has everything it needs. The slower parts usually sit outside ACHC: your state license, building a patient census and, in 2026, waiting for Medicare enrollment to reopen. That’s why starting preparation while you wait shortens the overall timeline instead of adding to it.

ACHC, CHAP or The Joint Commission?

All three hold CMS deeming authority for home health and hospice. CHAP is a nonprofit founded in 1965 that focuses only on care delivered at home. The Joint Commission accredits most care settings and runs one Home Care program covering home health, hospice and personal care. ACHC accredits home health, hospice and private duty home care. Your choice depends on your service lines, the support you want and your budget. Because all three check you against the same Medicare Conditions of Participation for deemed status, most ACHC accreditation preparation work carries over if you choose another accreditor. For a side-by-side view, read our earlier piece on why a license alone isn’t enough.

How Cura helps

Our ACHC accreditation preparation service gets new home health and hospice agencies ready at one fixed price: a readiness assessment, survey preparation, and follow-up through to the decision. See our accreditation support service for what’s included.

Planning a Medicare-certified agency? Book a free discovery call and we’ll map your path from state license to accreditation survey.

This article is general information, not legal advice. ACHC procedures and CMS rules change, so confirm current requirements with ACHC and CMS before you apply.