Home Health Agency (HHA) Center
- Register for the February 12, 2019 Home Health Patient-Driven Groupings Model MLN Call
- During this call, learn about the Patient-Driven Groupings Model (PDGM) that will be implemented on January 1, 2020. The PDGM is a case-mix adjustment methodology that will adjust home health payments, based on patient characteristics for 30-day periods of care, to home health agencies providing home health services under Medicare Fee-For-Service.
- For more information, visit the 2-12-19 call detail webpage.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1689-FC) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019. The final rule results in a 2.2 percent increase ($420 million) in payments to HHAs in CY 2019 and finalizes the methodology used to determine the rural add-on payment for CYs 2019 through 2022 as well as regulations text changes regarding certifying and recertifying patient eligibility for Medicare home health services and remote patient monitoring. This rule also finalizes the removal of seven measures from the Home Health Quality Reporting Program, a regulatory text change regarding OASIS data, and refinements the Home Health Value-Based Purchasing model. For CY 2020, this rule finalizes the implementation of an alternative case-mix adjustment methodology, the Patient Driven Groupings Model (PDGM). The PDGM will be implemented in a budget neutral manner on January 1, 2020. A Home Health Claims-OASIS Limited Data Set (LDS) file will be made available, upon request, to accompany the CY 2019 HH PPS final rule (click here). Lastly, this rule finalizes the definition of a “infusion drug administration calendar day” for the implementation of temporary transitional payments for home infusion therapy services for CYs 2019 and 2020, finalizes health and safety standards for home infusion therapy, and finalizes an accreditation and oversight process for home infusion therapy suppliers.
- CY 2019 HH PPS Wage Index [ZIP, 104KB]
- CY 2019 HH PPS Case Mix Weights [ZIP, 166KB]
- CY 2019-CY 2022-Rural-Add-On-Payment Designations [ZIP, 134KB]
- Overview of the Patient-Driven Groupings Model [PDF, 449KB]
- Analysis Comparing BLS vs. Cost Report Case-Mix Weights [ZIP, 122KB]
- PDGM Case Mix Weights and LUPA Thresholds [ZIP, 45KB]
- PDGM Grouper Tool CY 2019 (Updated 11/06/2018) [ZIP, 1MB]
- PDGM Agency Level Impacts [ZIP, 938KB]
Home Health, Hospice and DME Open Door Forum
Physician Certification of Patient Eligibility for the Medicare Home Health Benefit
MLN Connects™ National Provider Call - Certifying Patients for the Medicare Home Health Benefit (December 16, 2014). This MLN Connects™ National Provider Call provided an overview of certifying patient eligibility for the Medicare home health benefit. This included a summary of the new requirement for HHAs to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient that served as the basis for the certification of patient eligibility, which was finalized in the Calendar Year 2015 Home Health Prospective Payment System (HH PPS) final rule (CMS-1611-F) and effective for episodes of care beginning on or after January 1, 2015. For links to the presentation, examples, and transcripts, visit this MLN Connects™ National Provider Call web page.
MLN Connects Newsletter
- Subscribe now to receive the weekly MLN Connects® newsletter for the latest Medicare Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
For questions about home health payment policy, send your inquiry via email to: HomehealthPolicy@cms.hhs.gov.
Billing / Payment
- Home Health PPS
- Coding and Billing Information
- Home Health Prospective Payment System (HH PPS) PC Pricer
- Home Health PPS Software
- Updated ICD-10 Translation List – (Revised 10/27/16) [ZIP, 1MB]
- ICD-10-CM Final Manifestation and Etiology Code List [ZIP, 836KB]
- Home Health Quality Reporting Program
- Home Health Compare - Opens in a new window
- Beneficiary Notices Initiative (BNI)
- FFS HHCCN
- FFS Expedited Determination Notices
Outcome and Assessment Information Set (OASIS)
- Outcome and Assessment Information Set (OASIS)
- OASIS User Manuals
- Statement of Patient Privacy Rights in English and Spanish (Zip, 1.5 MB) [ZIP, 1MB]
Research and Analyses
- Medicare Home Health Prospective Payment System Case-Mix Methodology Refinements Overview of the Home Health Groupings Mode [ZIP, 2MB]
- Report to Congress on the Medicare Home Health Study An Investigation on Access to Care and Payment for Vulnerable Patient Populations [ZIP, 8MB]
- "Analyses in Support of Rebasing & Updating the Medicare Home Health Payment Rates – CY 2014 Home Health Prospective Payment System Final Rule” Technical Report [PDF, 701KB]
- "Analyses in Support of Rebasing & Updating the Medicare Home Health Payment Rates – CY 2014 Home Health Prospective Payment System Proposed Rule” Technical Report [PDF, 486KB]
- Home Health Study Report - Independent Review of the Models to Assess Nominal Case-Mix Growth [PDF, 261KB]
- Home Health Case-Mix Changes 2000-2009 Report & Tables [ZIP, 1.65MB]
- Revision of the Case-Mix Weights for the HH PPS Report, Figures & Tables [ZIP, 2.1MB]
- Analysis of 2000-2008 Home Health Case-mix Change Report [ZIP, 609KB]
- Refinement of Medicare's Home Health Prospective Payment System: Final Report [PDF, 2MB] and the Appendix containing associated tables [PDF, 966KB]
- Analysis of 2006-2007 Home Health Case-Mix Change: Final Report [PDF, 1MB]
CMS Manuals & Transmittals
Participation, Enrollment & Certification
- Home Health Agencies
- Conditions of Participation: Home Health Agencies (42 CFR 484.1)
- Medicare Provider-Supplier Enrollment
How to Stay Informed
- Subscribe now to receive the weekly MLN Connects Provider eNews for the latest Fee-For-Service program information, event announcements, claims and pricer information, and MLN educational product updates.
- Home Health, Hospice & Durable Medical Equipment Open Door Forum
- Press Releases - Opens in a new window