On June 28, 2021, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1747-P) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2022. The proposed rule results in an estimated 1.7 percent increase ($310 million) in payments to HHAs in CY 2022.
Additionally, this rule provides monitoring and analysis of the Patient-Driven Groupings Model (PDGM); solicits comments on a methodology for determining the difference between assumed versus actual behavior change on estimated aggregate expenditures for home health payments as result of the change in the unit of payment to 30 days and the implementation of the PDGM case-mix adjustment methodology; proposes to maintain the CY 2021 low utilization payment adjustment (LUPA) thresholds; and proposes to recalibrate the PDGM case-mix weights, functional levels, and comorbidity adjustment subgroups for CY 2022. This rule also proposes to utilize the physical therapy LUPA add-on factor to establish the occupational therapy add-on factor for the LUPA add-on payment amounts; and make conforming regulations text changes to reflect that allowed practitioners are able to establish and review the plan of care. Finally, this rule includes updates to the home infusion therapy services payment rates for CY 2022, as required by section 1834(u) of the Act.
A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2022 HH PPS proposed rule. Please visit the Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS) webpage for more information.
- CY 2022 HH PPS Wage Index (ZIP)
- CY 2022-Rural-Add-On-Payment Designations (ZIP)
- CY 2022 PDGM Case Mix Weights and LUPA Thresholds (ZIP)
- CY 2022 Comorbidity Adjustment Diagnosis List (ZIP)
ABN Form Renewal
The Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131 (ZIP)) and instructions (PDF) for renewal. You must use the renewed form with the expiration date of June 30, 2023, beginning August 31. There are no other changes to the form. Visit the ABN webpage for more information.
Implementation of New International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Diagnosis Codes, Effective April 1, 2020:
The Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) has implemented two new ICD-10-CM diagnosis codes, effective April 1, 2020:
- In response to the national emergency that was declared concerning the COVID-19 outbreak, NCHS is implementing a new diagnosis code, U07.1, COVID-19, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and;
- In response to recent occurrences of vaping related disorders, the NCHS is implementing a new diagnosis code, U07.0, Vaping-related disorder, into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting vaping-related disorders.
CMS finalized a new case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM relies more heavily on clinical characteristics, and other patient information to place home health periods of care into meaningful payment categories. One case-mix variable is the assignment of the principal diagnosis to one of 12 clinical groups to explain the primary reason for home health services.
Both U07.1, COVID-19 and U07.0, Vaping-related disorder will be assigned to the Medication Management, Teaching and Assessment-Respiratory (MMTA-Respiratory) clinical group for purposes of case-mix adjustment under the HH PPS. Additionally, U07.1, COVID-19, will be added to a new comorbidity subgroup, Respiratory 10, and will receive the Low Comorbidity adjustment under the HH PPS case-mix system. The clinical group assignment for U07.1, COVID-19, and Vaping-related Disorder, U07.0, and the Low Comorbidity adjustment for COVID-19, U07.1 will be included in the Home Health Patient-Driven Groupings Model (HH PDGM) Grouper software package, v01.1.20, available for download on the HH Grouper Software webpage. It is effective for home health claims with From Dates on or after April 1, 2020.
Home Health, Hospice and DME Open Door Forum
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For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.