On October 29, 2020, CMS issued a final rule [CMS-1730-F] that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2021. The rule results in an estimated 1.9 percent increase ($390 million) in payments to HHAs in CY 2021. This rule finalizes regulatory changes related to telecommunications technologies in providing care under the Medicare home health benefit beyond the COVID-19 PHE and finalizes the adoption of the most recent Office of Management and Budget statistical area delineations and applies a 5 percent cap on wage index decreases in CY 2021 only. A Home Health Claims-OASIS Limited Data Set (LDS) file is available, upon request, to accompany the CY 2021 HH PPS final rule. Please visit the Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS) webpage for more information. Finally, this rule updates the CY 2021 home infusion therapy services payment rates.
- CY 2021 HH PPS Wage Index (ZIP)
- CY 2021-CY 2022-Rural-Add-On-Payment Designations (ZIP)
- CY 2021 PDGM Case Mix Weights and LUPA Thresholds (ZIP)
- Updated CY 2021 Home Infusion Therapy Geographic Adjustment Factors (GAFs)- January 2021 (ZIP)
- Updated CY 2021 Final National Home Infusion Therapy Rates- January 2021 (ZIP)
- Updated CY 2021 Home Infusion Therapy Locality Adjusted Payment Rates- January 2021 (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.