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 in a given year. Observations are stripped of most data elements that will permit identification of beneficiaries. As described in the final rule that presents the 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements, CMS finalized refinements to the HH payment system that change the length of a home health episode from 60-day to 30-days. This change meets the requirements of section 51001(a) of the Bipartisan Budget Act of 2018 to use 30-day periods. 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 episode/period
- Payment adjustors used for the episode/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 episodes/periods 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.
- The final rule that presents the 2019 Home Health Prospective Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements that can be found through the Related Links section below.
Data Format: Comma separated variable block with SAS® read-in program
Available: CY 2018
To browse the record layout, see the Downloads section below.