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Home Health Agency (HHA) Center

  • CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value Based Purchasing Model; and Home Health Quality Reporting Requirements: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1625-P) that would update the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2016. In the CY 2016 proposed rule, CMS is implementing the third year of the four year phase-in of the rebasing adjustments to the HH PPS payment rates required by the Affordable Care Act. In addition,  CMS is proposing to decrease the national, standardized 60-day episode payment amount by 1.72 percent in each year for CY 2016 and CY 2017 to account for nominal case-mix growth between CY 2012 and CY 2014 and proposing updates to the Home Health Quality Reporting Program.  Finally, CMS is proposing to implement a Home Health Value-Based Purchasing (HHVBP) model effective for CY 2016. CMS estimates that the net impact of this proposed rule would result in a decrease in Medicare payments to HHAs of 1.8 percent ($350 million decrease) for CY 2016.

ATTENTION:  There was a misalignment between the case-mix weights and the payment groups in Table 9 of the CY 2016 HH PPS Proposed Rule (CMS-1625-P).  The corrected case-mix weights are posted below and a correction notice was published on August 4, 2015 ( CMS-1625-CN - Opens in a new window ).

        [CORRECTED TABLE 9 - CY 2016 Proposed Case-Mix Weights] [ZIP, 13KB]

  • Star Ratings for Home Health Compare Webinar:  Register for a  webinar on Thursday, March 26 from 1-2pm ET  on the new Home Health Compare (HHC) “Star” Ratings Provider Preview Reports and the process for requesting review of the rating. More information is available on the Home Health Star Ratings web page.
  • 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.
  • 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

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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