Home Health Services
Home health is a covered service under the Part A Medicare benefit. It consists of part-time, medically necessary, skilled care (nursing, physical therapy, occupational therapy, and speech-language therapy) that is ordered by a physician.
In 2019, there were 10,591 Medicare certified home health agencies throughout the United States. In 2019, 5,266,931 beneficiaries were served through 7,439,849 quality episodes of care. These counts include Medicare Fee for Service (FFS), Medicare Advantage and Medicaid beneficiaries for whom Outcome and Assessment Information Set (OASIS) data collection is required. In 2019, of these quality episodes, 8.4 percent were paid (at least partially) by Medicaid, 31.2 percent by Medicare Advantage, and the remaining 60.4 percent by Medicare FFS.
What's the CMS Quality Strategy?
CMS's Quality Strategy vision for improving health delivery can be said in three words: better, smarter, healthier. CMS is focusing on:
- Using incentives to improve care.
- Tying payment to value through new payment models.
- Changing how care is given through:
- Better teamwork.
- Better coordination across healthcare settings.
- More attention to population health.
- Putting the power of healthcare information to work
The Strategy is coordinated with the six priorities from the Agency for Healthcare Research and Quality's National Quality Strategy. Each priority is a goal in our Quality Strategy.
What are the CMS Quality Strategy's goals?
CMS's Quality Strategy goals are to:
- Make care safer by reducing harm caused while care is delivered.
- Improve support for a culture of safety.
- Reduce inappropriate and unnecessary care.
- Prevent or minimize harm in all settings.
- Help patients and their families be involved as partners in their care.
- Promote effective communication and coordination of care.
- Promote effective prevention and treatment of chronic disease.
- Work with communities to help people live healthily.
- Make care affordable.
Reporting Home Health Quality using OASIS Data
The instrument/data collection tool used to collect and report assessment data by home health agencies is called the Outcome and Assessment Information Set (OASIS). Since 1999, CMS has required Medicare-certified home health agencies to collect and transmit OASIS data for all adult patients whose care is reimbursed by Medicare and Medicaid with the following exceptions: patients under the age of 18, patients receiving maternity services, patients receiving only chore or housekeeping services. OASIS data are used for multiple purposes including calculating several types of quality reports which are provided to home health agencies to help guide quality and performance improvement efforts.
OASIS-D1 is the current version of the OASIS data set. The OASIS-D1 All Items instrument and the OASIS-D1 Follow-Up instrument were revised to accommodate the changes effective January 1, 2020. The original OASIS-D versions for all other time points remain in effect as of January 1, 2020. OASIS-D was approved by the Office of Management and Budget (OMB) on December 6, 2018, with an expiration date of 12/31/2021. The valid OMB control number for this information collection is 0938-1279.
CMS is delaying the release of the updated version of the OASIS (OASIS-E) to provide maximum flexibilities for home health agencies to respond to the COVID-19 Public Health Emergency (PHE). The release of the updated version of the OASIS will be delayed until January 1st of the year that is at least 1 full calendar year after the end of the COVID-19 PHE. For example, if the COVID-19 PHE ends on April 30, 2021, home health agencies will be required to begin collecting data using the updated versions of the item sets beginning with patients discharged on January 1, 2023.
Quality Reporting on Care Compare website
CMS posts a subset of OASIS-based quality performance information on the Care Compare website. These publicly-reported measures include outcome measures, which indicate how well home health agencies assist their patients in regaining or maintaining their ability to function and process measures, which evaluate the rate with which home health agencies use specific evidence-based processes of care. CMS also reports information on Medicare fee-for-service claims-based measures and Home Health CAHPS® (Consumer Assessment of Healthcare Providers and Systems) measures on Care Compare.
Lists of all home health quality measures and designation of which are publicly reported can be found on the Home Health Quality Measures webpage accessed from the list on the left of this page. For more information on the Home Health Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, please visit the official HH CAHPS® webpage.
Star ratings are other prominent features of the Care Compare website that summarize some of the current measures of home health care provider performance that are publicly reported. The star ratings are an additional tool to support consumers' health care decision-making.
You can find the latest developments for Home Health Services in the CY 2021 Home Health Prospective Payment System Final Rule in the Federal Registrar.