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.
On June 25, 2020, CMS issued a proposed rule [CMS-1730-P] that proposes routine updates to the home health payment rates for calendar year (CY) 2021, in accordance with existing statutory and regulatory requirements. This proposed rule also includes: a proposal to make permanent the regulatory changes related to telecommunications technologies in providing care under the Medicare home health benefit beyond the expiration of the public health emergency for the Coronavirus Disease 2019 (COVID-19) pandemic. This rule includes a proposal to adopt the revised Office of Management and Budget (OMB) statistical area delineations as described in OMB Bulletin 18-04 and proposes to apply a 5 percent cap on wage index decreases in CY 2021. Finally, this rule proposes Medicare enrollment policies for qualified home infusion therapy suppliers and updates the home infusion therapy services payment rates for CY 2021.
- 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)
- CY 2019- 2021 Home Infusion Therapy - Geographical Adjustment Factors (GAFs) (ZIP)
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.
HHAs: Avoid Payment Delays, Register for iQIES by December 23
Act now. Home Health Agencies (HHAs) need access to the upgraded Internet Quality Improvement and Evaluation System (iQIES) to submit assessment data beginning January 1. We will return claims that cannot be matched to assessments, delaying your Medicare payments. See the MLN Connects Special Edition article (PDF) SE 19025 for:
- Step-by-step instructions
- Training videos
- Frequently asked questions
- How to get help
Home Health Patient-Driven Groupings Model: Operational Issues Call– August 21, 2019
- The presentation (PDF), presentation clarification (PDF), audio recording (ZIP), and transcript (PDF) are available from the August 31 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. During this call, learn information to help your agency prepare to implement billing changes for the Patient-Driven Groupings Model (PDGM) on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.
Overview of the PDGM Model Medicare Learning Network Call – February 12, 2019
- The presentation (PDF), audio recording (ZIP), and transcript (PDF) are available from the February 12 call on the Home Health Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. CMS will use the PDGM to reimburse home health agencies.
Home Health, Hospice and DME Open Door Forum
Physician Certification of Patient Eligibility for the Medicare Home Health Benefit
MLN Connects Newsletter
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For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.