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Home Health Agency (HHA) Center - Centers for Medicare & Medicaid Services
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Home Health Agency (HHA) Center

Spotlights
  • Abt Associates convened a Technical Expert Panel (TEP) on February 1, 2018 to collect perspectives, feedback, and recommendations from a wide variety of industry experts and representatives regarding the public comments received on the Home Health Groupings Model (HHGM), as described in the CY 2018 Home Health Prospective Payment System (HH PPS) Proposed Rule (82 FR 35270). The TEP materials are now available for download. If you have any questions or comments on the TEP materials, please email Abt Associates at HomeHealth@abtassoc.com.

  • The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1672-F) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2018. CMS projects that Medicare payments to HHAs in CY 2018 will be reduced by 0.4 percent, or $80 million, based on the finalized policies. This decrease reflects the effects of a 1 percent home health payment update percentage ($190 million increase); a -0.97 percent adjustment to the national, standardized 60-day episode payment rate to account for nominal case-mix growth for an impact of -0.9 percent ($170 million decrease); and the sunset of the rural add-on provision for an impact of -0.5 percent ($100 million decrease). The rule also finalizes proposals for the Home Health Value-Based Purchasing (HHVBP) Model and the Home Health Quality Reporting Program (HH QRP). CMS is not finalizing the implementation of the Home Health Groupings Model (HHGM) in this final rule. The agency received many comments from the public that it would like to take into further consideration.

  • The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1672-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2018. The proposed policies included in the rule would result in a 0.4 percent decrease (-$80 million) in payments to HHAs in CY 2018.

    For CY 2019 payments, CMS proposes to implement an alternative case-mix adjustment methodology, the Home Health Groupings Model (HHGM). The HHGM would use 30-day periods, rather than 60-day episodes, and rely more heavily on clinical characteristics and other patient information (e.g., principal diagnosis, functional level, comorbid conditions, referral source, and timing) to place patients into more meaningful payment categories.

    For the HH Quality Reporting Program (QRP), CMS is proposing to adopt for the CY 2020 payment determination three measures to meet the requirements of the IMPACT Act and new standardized data elements. To reduce provider burden, CMS is proposing to remove or modify current OASIS items. CMS is also proposing processes for requesting reconsideration of determinations regarding compliance with pay-for-reporting requirements, as well as a process for providing exceptions to these policies and extensions to reporting timeframes. Lastly, CMS is also proposing changes to the Home Health Value-Based Purchasing (HHVBP) Model.

              Downloads:
  • MLN Connects® National Provider Call – Home Health Groupings Model Technical Report Call (January 18, 2017)

    This MLN Connects™ National Provider Call will provide an overview of the Home Health Groupings Model (HHGM). This technical report describes efforts to reassess the current HH PPS and develop large-scale payment methodology changes. During this call, CMS experts introduce the HHGM model. A question and answer session follows the presentation. Prior to the call, participants are encouraged to review the technical report. For links to the free registration, visit this MLN Connects® National Provider Call web page.

  • Medicare Home Health Prospective Payment System Case-Mix Methodology Refinements: Overview of the Home Health Groupings Model - Opens in a new window

    This technical report describes efforts to date on reassessing the current Home Health Prospective Payment System (HH PPS) and developing potentially large-scale payment methodology changes to better align payment with patient  needs, to address          payment incentives and vulnerabilities in the current system, and to respond to the concerns laid out in the prior Home Health Study Report to Congress, required by section 3131(d) of the Affordable Care Act, and from the Medicare Payment Advisory Commission. The report specifically discusses one potential model called the Home Health Groupings Model. Any questions or comments about this Technical Report should be sent to: HomeHealth@abtassoc.com.

    HHGM ICD-9-CM Codes for Clinical Groupings and Comorbidities [ZIP, 290KB]

  • Report to Congress on the Medicare Home Health Study: An Investigation on Access to Care and Payment for Vulnerable Patient Populations
    Section 3131(d) of the Affordable Care Act required that CMS conduct a study on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically under served areas, and in treating beneficiaries with varying levels of severity of illness (“vulnerable patient populations”) and submit a report to Congress.  View the report to Congress and Appendix in the links below.

Home Health, Hospice and DME Open Door Forum

Physician Certification of Patient Eligibility for the Medicare Home Health Benefit

  • MLN Matters® SE1436: Certifying Patients for the Medicare Home Health Benefit

  • MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014). This MLN Connects™ National Provider Call provided an overview of certifying patient eligibility for the Medicare home health benefit. This included a summary of the new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility, which was finalized in the Calendar Year 2015 Home Health Prospective Payment System (HH PPS) final rule (CMS-1611-F) and effective for episodes of care beginning on or after January 1, 2015. For links to the presentation, examples, and transcripts, visit this MLN Connects™ National Provider Call web page.

  • MLN Matters® MM8444: Clarification of the Definition of "Confined to the Home"

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