Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS)
The “Home Health Claims – OASIS” Limited Data Set (LDS) file contains information on the utilization of the Medicare Home Health (HH) benefit. The file is constructed so that each observation represents a particular home health episode/period in a given year. Observations are stripped of most data elements that will permit identification of beneficiaries. Section 51001 of the Bipartisan Budget Act of 2018 (BBA of 2018) included several requirements for home health payment reform, effective January 1, 2020. These requirements include the elimination of the use of therapy thresholds for case-mix adjustment and a change from a 60-day unit of payment to a 30-day unit of payment. Additionally, as finalized in the CY 2019 Home Health Prospective Payment System Rate Update and the CY 2020 Case-Mix Adjustment Methodology Refinements final rule, there is a new case-mix adjustment methodology that accompanies the change in the unit of payment and the elimination of therapy thresholds.
As such, this data file was constructed by splitting the current 60-day home health episodes into two 30-day periods. Each observation in the file represents a single 30-day period. However, some variables on the file were drawn from the 60-day episode from which the 30-day period was constructed, as indicated in the variable description. Information in this file includes:
- Start and end dates of the 30-day periods and 60-day episodes
- Wage index value associated with each episode/period
- Information regarding the resource use of the period
- HIPPS codes
- Case-mix weights
- Indicators for whether the episode/period receives a payment adjustment (LUPA, PEP, outlier)
- Actual and simulated payments for the episode/period
- Information on number and length of visits that occur during the episode/period
- Select information from the Outcome and Assessment Information Set (OASIS) that is used in the payment system.
NOTE: Any given “Home Health Claims – OASIS” file represents a static snapshot of a specific episode/period at the time the data was sourced from NCH. As such, any given record DOES NOT NECESSARILY represent the final coding and/or payment information for that episode/period because if subsequent adjustments to the claims occur after the “Home Health Claims – OASIS” file is completed, they will not be reflected on the file.
The “Home Health Claims – OASIS” LDS file will be updated twice a year. The first update will correspond to annual notices of proposed rulemaking, released in the early summer, and the second update will correspond to final rules released in the fall. Further information on the variables in the file can be found from:
- The variable layout that accompanies this file under the Downloads section below.
- Visit the for current regulations that presents HH PPS rate updates and case-mix adjustment methodology refinements
Data Format: Comma separated variable block with SAS® read-in program
Available: CY 2019
To browse the record layout, see the Downloads section below.