Home Health Agency (HHA) Center
Home Health Patient-Driven Groupings Model: Operational Issues Call
Wednesday, August 21, 2019, from 1:30 to 3 pm ET
Register for this call.
Learn information to help your agency prepare to implement billing changes for the Patient-Driven Groupings Model (PDGM) on January 1, 2020. CMS will use the PDGM to reimburse home health agencies for providing home health services under Medicare fee-for-service.
For more details on this call, visit the detail webpage.
- CY 2020 HH PPS Wage Index
- CY 2019 HH PPS Case Mix Weights for 60-day episodes into CY 2020
- CY 2019-CY 2022-Rural-Add-On-Payment Designations
- CY 2020 PDGM Case Mix Weights and LUPA Thresholds (Updated 07/12/2019)
- CY 2020 PDGM Grouper Tool
- CY 2020 PDGM Agency Level Impacts
- CY 2019 Home Infusion Therapy - Geographical Adjustment Factors (GAFs)
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1711-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2020. The proposed rule results in a 1.3 percent increase ($250 million) in payments to HHAs in CY 2020. This rule also implements the Patient‑Driven Groupings Model (PDGM), a revised case‑mix adjustment methodology, for home health services beginning on or after January 1, 2020. This proposed rule also implements a change in the unit of payment from 60‑day episodes of care to 30-day periods of care, as required by section 51001 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) and proposes a 30-day payment amount for CY 2020. Additionally, this proposed rule proposes to: modify the payment regulations pertaining to the content of the home health plan of care; allow physical therapy assistants to furnish maintenance therapy; and change the split percentage payment approach under the HH PPS. A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2020 HH PPS final rule (click here). This rule also set forth routine updates to the home infusion therapy payment rates for CY 2020 and proposes payment provisions for home infusion therapy services for CY 2021 and subsequent years.
Overview of the PDGM Model Medicare Learning Network Call – February 12, 2019
- The presentation, audio recording, and transcript are available from the February 12 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.
Home Health, Hospice and DME Open Door Forum
Physician Certification of Patient Eligibility for the Medicare Home Health Benefit
MLN Connects Newsletter
- Subscribe now to receive the weekly MLN Connects® newsletter for the latest Medicare Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.
Billing / Payment
- Home Health PPS
- Home Health Patient-Driven Groupings Model
- Home Infusion Therapy Services
- Coding and Billing Information
- Home Health Prospective Payment System (HH PPS) PC Pricer
- Home Health PPS Software
- Updated ICD-10 Translation List – (Revised 10/27/16) [ZIP, 1MB]
- ICD-10-CM Final Manifestation and Etiology Code List [ZIP, 836KB]
- Home Health Quality Reporting Program
- Home Health Compare - Opens in a new window
- Beneficiary Notices Initiative (BNI)
- FFS HHCCN
- FFS Expedited Determination Notices
Outcome and Assessment Information Set (OASIS)
- OASIS User Manuals
- Statement of Patient Privacy Rights in English and Spanish (Zip, 1.5 MB) [ZIP, 1MB]
Research and Analyses
- Medicare Home Health Prospective Payment System Case-Mix Methodology Refinements Overview of the Home Health Groupings Mode [ZIP, 2MB]
- Report to Congress on the Medicare Home Health Study An Investigation on Access to Care and Payment for Vulnerable Patient Populations [ZIP, 8MB]
- "Analyses in Support of Rebasing & Updating the Medicare Home Health Payment Rates – CY 2014 Home Health Prospective Payment System Final Rule” Technical Report [PDF, 701KB]
- "Analyses in Support of Rebasing & Updating the Medicare Home Health Payment Rates – CY 2014 Home Health Prospective Payment System Proposed Rule” Technical Report [PDF, 486KB]
- Home Health Study Report - Independent Review of the Models to Assess Nominal Case-Mix Growth [PDF, 261KB]
- Home Health Case-Mix Changes 2000-2009 Report & Tables [ZIP, 1.65MB]
- Revision of the Case-Mix Weights for the HH PPS Report, Figures & Tables [ZIP, 2.1MB]
- Analysis of 2000-2008 Home Health Case-mix Change Report [ZIP, 609KB]
- Refinement of Medicare's Home Health Prospective Payment System: Final Report [PDF, 2MB] and the Appendix containing associated tables [PDF, 966KB]
- Analysis of 2006-2007 Home Health Case-Mix Change: Final Report [PDF, 1MB]
CMS Manuals & Transmittals
Participation, Enrollment & Certification
- Home Health Agencies
- Conditions of Participation: Home Health Agencies (42 CFR 484.1)
- Medicare Provider-Supplier Enrollment
How to Stay Informed
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Home Health, Hospice & Durable Medical Equipment Open Door Forum
- Press Releases - Opens in a new window