A home health aide training and competency program addresses the qualifications, training, evaluation and in-service requirements in 42 CFR 484.80 for HHAs subject to this condition of participation. Agencies may use qualified outside providers and the qualification routes in paragraph (a)(1). Integral Healthcare Solutions (IHS) drafts the program, forms and calendar for your nurse leaders to approve.
Last updated: November 2026
What does 42 CFR 484.80 require for home health aide training?
It sets aide qualification routes, training and competency standards, and in-service requirements. Paragraph (b)(1) says: "Classroom and supervised practical training must total at least 75 hours." Paragraph (c) says: "An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section."
The governing text is 42 CFR 484.80, "Condition of participation: Home health aide services." We read it on November 5, 2026 in the current eCFR text, built November 4, 2026. Its amendment history ends with a rule published November 9, 2021 (86 FR 62421). This page covers paragraphs (a) through (f), not (g) assignments, (h) supervision visits or (i) Medicaid personal care aides.
| Paragraph | What it asks, in IHS's words | What shows it |
|---|---|---|
| (a)(1) | A person is a qualified aide after successfully completing one of four routes: a home health aide training and competency evaluation program under (b) and (c); a competency program that meets (c); a State-approved nurse aide program under sections 483.151 through 483.154, with the person currently listed in good standing on the State nurse aide registry; or a State licensure program that meets (b) and (c). | Program record per aide; registry check |
| (a)(2) | After the most recent program completion, a continuous 24-month period without compensated services described in § 409.40 invalidates that completion. The aide must complete another program specified in (a)(1) before providing services. | Service history in the hiring file |
| (b)(1), (b)(2) | Classroom and supervised practical training total at least 75 hours. Practical training takes place in a practicum laboratory or other setting, with the trainee demonstrating knowledge while providing services to an individual under the direct supervision of a registered nurse, or of a licensed practical nurse supervised by a registered nurse. At least 16 classroom hours come before at least 16 practical hours, within the 75. The program addresses every (b)(3) subject; (b)(3)(xv) also requires the HHA to train aides as needed in skills beyond the basic checklist. | Curriculum map keyed to each subject |
| (c), (c)(1) | An individual furnishes home health services only after successfully completing a competency evaluation program. Every (b)(3) subject must be evaluated. Five require observation with a patient or pseudo-patient; the rest may be evaluated by written or oral examination or by observation, including simulation (see the FAQ). | Evaluation record on file before assignment |
| (c)(3) | A registered nurse performs the competency evaluation, in consultation with other skilled professionals, as appropriate. | Evaluator name and credentials |
| (d), (d)(1) | An aide receives at least 12 hours of in-service training in each 12-month period. Any organization may offer it, and a registered nurse must supervise it. | In-service log and hours tally |
| (e) | Classroom and supervised practical training are performed by a registered nurse with at least 2 years of nursing experience, at least 1 year of it in home health care, or by other individuals under that nurse's general supervision. | Instructor qualification file |
| (b)(4), (c)(5), (d)(2) | For each standard, the HHA maintains documentation that demonstrates the requirements have been met. | Training, evaluation and in-service records |
The right-hand column gives IHS’s suggested evidence, not prescribed record titles.
Who needs it and what triggers it?
For HHAs subject to this condition of participation, these are potential reasons to review aide qualifications and records. They are IHS’s reading as of November 5, 2026, not a CMS trigger list.
- The agency has gaps in its aide records.
- A new agency is building its aide program.
- An aide has had a long break in service, which can send the aide back through a program under paragraph (a)(2).
- The agency wants to run its own training or competency program, which paragraph (f) bars after certain events in the previous 2 years.
Paragraph (f) permits any organization to offer training and competency evaluation except an HHA with a disqualifying event within the previous 2 years. Examples include noncompliance with (b), (c), (d) or (e), and a civil monetary penalty of at least 5,000 dollars as an intermediate sanction. These are examples only; check every ground in paragraph (f)(1)–(7) before the agency offers either program.
How IHS helps
IHS runs a gap assessment against paragraphs (a) through (f), maps the evidence you hold, and drafts what is missing: the program, a curriculum map to the 75 hours and the (b)(3) subjects, competency evaluation forms that name the method for each subject, an in-service calendar, records forms and an aide qualification checklist. IHS then conducts a mock document review and supports readiness; your clinicians approve clinical content. Integral Healthcare Solutions (IHS) was founded in 2002 by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, and works across accreditation consulting, compliance services and program development. This build sits in our Compliance Services practice line.
Your agency supplies the aide roster, credentials, registry listings and training records, the registered nurses who evaluate competency and supervise training and in-service, plus your agency policies and State law requirements.
IHS does not teach aides or evaluate competency. Under (c)(3), an RN evaluates in consultation with other skilled professionals as appropriate. Under (e), instructors are RNs with at least 2 years’ nursing experience, including at least 1 in home health care, or individuals under their general supervision. IHS does not communicate with CMS, state agencies or accreditors for clients. State requirements were not reviewed.
What to have ready
Each item below is IHS’s suggested evidence for the cited paragraphs of 42 CFR 484.80, Condition of participation: Home health aide services (current eCFR; page opened November 5, 2026).
- Aide roster with credentials, registry listings, prior program records and service history for any aide with a long break (paragraphs (a)(1) and (a)(2)).
- Training curriculum with hours by unit, the supervising nurse and a map to each (b)(3) subject (paragraphs (b)(1) to (b)(3)).
- Training records of each aide's classroom and practical hours (paragraph (b)(4)).
- Competency evaluations on file before assignment, naming the evaluating registered nurse and the method for each subject (paragraphs (c), (c)(1) and (c)(3)).
- The rule your evaluation form applies to an unsatisfactory rating, with the task restriction and retraining (paragraph (c)(4)).
- An in-service log per aide for the current 12-month period, with the supervising registered nurse (paragraph (d)).
- Instructor qualification files with nursing experience, and supervision of other instructors (paragraph (e)).
- If the agency offers training or competency evaluation, the last 2 years of survey and enforcement history (paragraph (f)), and your State's aide training rules.
If several are missing, book the free introductory call and bring what you have.
How does outside drafting support compare with other routes?
An agency can build internally, use an outside training organization, or obtain drafting support. Paragraph (f) limits which HHAs may offer training and competency evaluation. Under (d)(1), any organization may offer RN-supervised in-service training. An internal build uses nurse leader time; IHS adds drafting and review support while your clinicians retain clinical responsibility. For accreditation context, see our home health and hospice page.
What does it cost?
The reviewed section, 42 CFR 484.80, contains no fee schedule; this does not establish whether other authority fees apply. IHS scopes each engagement after a free introductory call. Scope depends on branches, aide roster size and existing records. Agency staff time also affects the cost.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm, and your counsel confirms State law. It is not a guarantee of any survey result. IHS does not train aides, perform evaluations or submit anything to CMS, a state agency or an accreditor; your agency does.
Frequently asked questions
What does 42 CFR 484.80 require for home health aide training?
An HHA must use aides qualified under paragraph (a)(1), which includes a competency-evaluation route. Training under paragraph (b) totals at least 75 hours; paragraph (c) requires successful competency evaluation before services, and paragraph (d) requires at least 12 in-service hours per 12-month period.
How many hours of training must a home health aide have?
Training under paragraph (b) totals at least 75 hours, including at least 16 classroom hours before at least 16 supervised practical hours. Paragraph (a)(1) also provides other qualification routes. State-specific requirements are outside this review.
How many in-service hours must a home health aide complete each year?
At least 12 hours of in-service training during each 12-month period. Any organization may offer it, and a registered nurse must supervise it. It may occur while the aide is furnishing care to a patient.
Who can perform a home health aide competency evaluation?
A registered nurse, in consultation with other skilled professionals, as appropriate. Any organization may offer the program, except an HHA barred by paragraph (f). IHS drafts the forms; the nurse performs the evaluation.
Which competency subjects must be evaluated by observing the aide with a patient?
Five subject areas in paragraph (b)(3): communication skills; reading and recording temperature, pulse and respiration; personal hygiene and grooming tasks; safe transfer techniques and ambulation; and normal range of motion and positioning. Each is evaluated by observing the aide perform the task with a patient or pseudo-patient. The rest may be evaluated by written or oral examination, or by observation with a patient or a pseudo-patient in a simulation.
What happens if an aide is rated unsatisfactory in a competency area?
The aide is not considered competent in that task and must not perform it without direct supervision by a registered nurse until the aide has received training in the task and has successfully completed a subsequent evaluation. An unsatisfactory rating in more than one of the required areas also means the aide has not successfully passed the competency evaluation.
Can a certified nursing assistant work as a home health aide?
Successful completion of a State-approved nurse aide training and competency evaluation program meeting §§ 483.151–483.154, plus current good standing on the State nurse aide registry, qualifies under (a)(1)(iii). If, since the most recent program completion, 24 consecutive months pass without compensated services described in § 409.40, another (a)(1) program is required before services.
What documentation must an agency keep for aide training?
Paragraphs (b)(4), (c)(5) and (d)(2) each say the HHA must maintain documentation that demonstrates the requirements of that standard have been met. The regulation names no record titles; IHS infers the file: curriculum and hours, competency evaluations, in-service logs and instructor qualification files.
What does a home health aide training program build cost?
The reviewed section, 42 CFR 484.80, contains no fee schedule; other authority fees were not verified. IHS scopes each engagement after a free introductory call. Scope depends on branches, aide roster size and existing records.