Building upon experience from the original Home Health Value-Based Purchasing Model (HHVBP Model), this page provides information, resources, and technical assistance to support implementation of the expanded HHVBP Model nationwide.
Have questions about the expanded HHVBP Model? Please send questions to HHVBPquestions@cms.hhs.gov. Be sure to include your name and the home health agency’s name and CCN.
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Background
As authorized by section 1115A of the Act and finalized in the Calendar Year (CY) 2016 Home Health Prospective Payment System (HH PPS) final rule (80 FR 68624), the Center for Medicare and Medicaid Innovation (Innovation Center) implemented the Home Health Value-Based Purchasing (HHVBP) Model (“original Model”) in nine (9) states on January 1, 2016. The specific goals of the original HHVBP Model were to:
- Provide incentives for better quality care with greater efficiency;
- Study new potential quality and efficiency measures for appropriateness in the home health setting; and
- Enhance the current public reporting process.
The original HHVBP Model resulted in an average 4.6 percent improvement in HHAs' total performance scores (TPS) and an average annual savings of $141 million to Medicare without evidence of adverse risks. The evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending. The U.S. Secretary of Health and Human Services and the CMS Chief Actuary determined that expansion of the original HHVBP Model would further reduce Medicare spending and improve the quality of care. On January 8, 2021, CMS announced the certification of the HHVBP Model for expansion nationwide, as well as the intent to expand the Model through notice and comment rulemaking.
The Expanded HHVBP Model
The expanded HHVBP Model began on January 1, 2022 and includes Medicare-certified HHAs in all fifty (50) states, District of Columbia, and the U.S. territories. Calendar Year (CY) 2022 was the pre-implementation year. During CY 2022, CMS provided HHAs with resources and training, to allow HHAs time to prepare and learn about the expectations and requirements of the expanded HHVBP Model without risk to payments. The first full performance year for the expanded HHVBP Model is CY 2023, which began on January 1, 2023. Calendar Year 2025 is the first payment year, with payment adjustment amounts determined by CY 2023 performance. In a payment year, an applicable percent ranging from -5% to 5% applies toward Medicare fee-for-service payments.
Model Summary
Under the expanded HHVBP Model, HHAs receive adjustments to their Medicare fee-for-service payments based on their performance against a set of quality measures, relative to their peers’ performance. Performance on these quality measures in a specified year (performance year) impacts payment adjustments in a later year (payment year). Cohorts are determined based on each HHA’s unique beneficiary count in the prior calendar year. HHAs are assigned to either a nationwide larger-volume cohort or nationwide smaller-volume cohort to group HHAs that are of similar size and are more likely to receive scores on the same set of measures for purposes of setting benchmarks and achievement thresholds and determining payment adjustments. For more details about the expanded Model, please see the HHVBP Resources section.
Quality Measures
The expanded HHVBP Model measure set currently uses data already reported by HHAs through the Home Health Quality Reporting Program (HH QRP) requirements, or Medicare claims, and HHCAHPS surveys. To reduce reporting burden, HHAs do not need to submit any additional data, at this time, for the expanded HHVBP Model. All expanded Model reports containing expanded Model performance data will be available through iQIES. The expanded Model measure categories and quality measures are shown below.
Measure Category
OASIS-based
- Improvement in Dyspnea/Dyspnea
- Discharged to Community
- Improvement in Management of Oral Medications/Oral Medications
- Total Normalized Composite Change in Self-Care/TNC Self-Care
- Total Normalized Composite Change in Mobility/TNC Mobility
Claims-based
- Acute Care Hospitalization During the First 60 Days of Home Health Use/ACH
- Emergency Department Use without Hospitalization During the First 60 Days of Home Health/ED Use
HHCAHPS Survey-based
- Care of Patients/Professional Care
- Communications between Providers and Patients/Communication
- Specific Care Issues/Team Discussion
- Overall rating of home health care/Overall Rating
- Willingness to recommend the agency/Willing to Recommend
HHVBP Resources
Resource Index
Expanded HHVBP Model YouTube Playlist
- Expanded HHVBP Model Playlist - all recorded content for the expanded HHVBP Model is posted here
Model Overview
- Webinar: Expanded HHVBP Model: Preparing for Calendar Year (CY) 2024 and CY 2025 – Thursday, November 9, 2023 2:00 pm ET
- Webinar: HHVBP Model Expansion 101 - Thursday, February 10, 2022 2:00 pm ET
FAQs & Model Guide
- Expanded HHVBP Model Frequently Asked Questions (PDF)
- Expanded HHVBP Model Guide - December 2023 (PDF)
- Making the Most of HHVBP Resources Instructional Recording
Model Reports
- Expanded HHVBP Model CY 2024 Annual Performance Report - What You Need to Know (August 13, 2024 3:00 p.m. ET)
- Expanded HHVBP Model Reports – Access Instructions (PDF)
- Expanded HHVBP Model IPR and APR Recalculation Instructions (PDF)
- Expanded HHVBP Model IPR Quick Reference Guide (PDF)
- Overview of the Interim Performance Report (IPR): The July 2023 IPR - July 27, 2023
- Webinar: Introduction to the Pre-Implementation Performance Report (PIPR) - November 17, 2022
Public Reporting
Newsletters
- HHVBP Model Newsletter September 2024 (PDF)
- HHVBP Model Newsletter June 2024 (PDF)
- HHVBP Model Newsletter March 2024 (PDF)
- HHVBP Model Newsletter December 2023 (PDF)
- Previous newsletters are available on the HHVBP Expanded Model Archived Materials page
Quality Measures
- Discharge Function Score (DC Function) Quality Measure Overview (PDF)
- Expanded HHVBP Model Web-Based Training: Changes to the Applicable Measure Set Beginning in CY 2025
- Risk Adjustment in the Expanded HHVBP Model (PDF)
- Calculating Episode-Level Observed Values for the Total Normalized Composite Change Measures (PDF)
- Calculating Episode-Level Predicted Values for the Total Normalized Composite (TNC) Change Measures (PDF)
- HHVBP Model: Quality Measures Used in the Expanded Model
- Technical Specifications for the Total Normalized Composite Change Measures - April 2023 (PDF)
- Technical Specifications for the Total Normalized Composite Change Measures - October 2021 (PDF)
- How to use Existing Quality Assurance and Performance Improvement (QAPI) Processes to Support Improvement in Expanded Home Health Value-Based Purchasing (HHVBP) Model (PDF)
Quality Improvement
- Recorded Panel: Home Health Agency Perspectives on Quality Management
- Recorded Panel: Home Health Agency Perspectives on Innovation
- Essentials Module: Patient and Family/Caregiver Engagement: Assessment and Goal Setting
- Essentials Module: Care Transitions: Provider Communication
- Essentials Module: Patient and Family/Caregiver Engagement: Teaching and Guidance
- Essentials Module: Care Transitions: Medication Management
- Webinar: Strategies for Success Self-Assessment Tool – March 30, 2023, 2:30pm ET
- Webinar: First Performance Year Quick Guide – January 19, 2023, 4:30 pm ET
- Leadership and Communication — Essential Elements for Quality Improvement Podcast
- The Patient with Declining Memory: The “Keys” to Safe Mobility Podcast
- Infection Prevention and Control: Home Health Patient Care and Communication Podcast
- Managing Chronic Illness through Home Health Care Podcast
- Quality Assessment and Performance Improvement (QAPI) Program Self-Assessment (PDF)
- Quality Measure Category-Focused Performance Improvement (PDF)
- Briefing Card Compendium (PDF)
Total Performance Score & Payment Adjustment
- How Measure Performance Becomes Care Points Instructional Video
- How Care Points Become the Total Performance Score (TPS)
- How the Total Performance Score (TPS) Becomes the Final Payment Adjustment
Health Equity
Regulations & Notices
- CY 2025 Home Health Prospective Payment System (HH PPS) Final Rule
- CY 2024 Home Health Prospective Payment System (HH PPS) Final Rule
- CY 2023 Home Health Prospective Payment System (HH PPS) Final Rule
- CY 2022 Home Health Prospective Payment System (HH PPS) Final Rule
Technical Expert Panel
Additional Information
- HHVBP Expanded Model Archived Materials page
- Original Home Health Value-Based Purchasing Model (HHVBP Model)
Outreach |
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If you are interested in receiving additional information, updates or have questions about the Expanded Home Health Value-Based Purchasing Model, please engage with the below resources:
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