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Home Health Agency (HHA) Center

  • 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.
  • MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014 at 1:30 pm ET).  This MLN Connects™ National Provider Call provides an overview of certifying patient eligibility for the Medicare home health benefit. This includes an overview of a 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. This new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule (CMS-1611-F) effective for home health episodes beginning on or after January 1, 2015.  For more information and to register, visit this MLN Connects™ National Provider Call web page.

  • Calendar Year (CY) 2015 Home Health Prospective Payment System (HH PPS) Final Rule  The Centers for Medicare & Medicaid Services (CMS) issued a final rule CMS-1611-F to update Medicare's HH PPS payment rates and wage index for CY 2015. As required by Section 3131(a) of the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments. Payments to home health agencies (HHAs) are estimated to decrease by approximately 0.30 percent, or -$60 million in CY 2015. This rule also finalizes changes to: simplify the face-to-face encounter regulatory requirements; update the HH PPS case-mix weights; revise the home health quality reporting program requirements; simplify the therapy reassessment timeframes; revise the Speech-Language Pathology (SLP) personnel qualifications; and limit the reviewability of the civil monetary penalty provisions. Lastly, this final rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of ICD-10-CM, and a HH value-based purchasing (HH VBP) model.  A technical correction notice CMS-1611-CN was issued to clarify that the changes finalized to the therapy reassessment timeframes are effective for episodes beginning on or after January 1, 2015.
  • Proposed Conditions of Participation The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule ( CMS-3819-P - Opens in a new window ) that would modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients. The proposed regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This proposed regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services;  streamlines regulatory requirements; and builds a foundation for ongoing, data-driven, agency-wide quality improvement.

  • Comply with MAC Request for Fingerprints within 30 Day

    CMS implemented the fingerprint-based background requirement on August 6, 2014, as discussed in the rule published on February 2, 2011. Fingerprint-based background checks are required for all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into the high risk category and is currently enrolled in Medicare or has submitted an initial enrollment application. Medicare Administrative Contractors (MACs) have begun sending letters to these providers and suppliers, listing all owners who are required to be fingerprinted. The letters are being mailed to the provider or supplier’s correspondence address and the special payments address on file with Medicare.

    Identified individuals have 30 days from the date of the letter to be fingerprinted. Failure to comply with the fingerprint requirements could result in denial of your Medicare enrollment application or revocation of your Medicare billing privileges.  Visit Accurate Biometrics for fingerprinting procedures, to find a fingerprint collection site, and to ensure the fingerprint results are accurately submitted to the Federal Bureau of Investigation (FBI) and properly returned to CMS. For more information on this requirement, see MLN Matters® Special Edition Article #SE1427, “Fingerprint-based Background Check Begins August 6, 2014.” If you have any questions, contact Accurate Biometrics at 866- 361-9944, or visit their website at  

  • Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet)
    As explained in the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet (see Downloads section on the SNF PPS web page), the Centers for Medicare & Medicaid Services (CMS) is issuing revised portions of the relevant program manuals used by Medicare contractors.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet) [PDF, 416KB] .  The Manual Updates to Clarify Skilled Nursing Facility (SNF), Inpatient Rehabilitation Facility (IRF), Home Health (HH), and Outpatient (OPT) Coverage Pursuant to Jimmo vs. Sebelius can be found in CR 8458 and in associated MLN Matters Article, MM8458.

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