Notice: In accordance with Section 4142 of the Consolidated Appropriations Act of 2023, CMS is releasing a data file showing the simulated 60-day episodes under the home health prospective payment system in effect prior to implementation of the Patient Driven Groupings Model, using data from 30-day periods paid under such Model, used to determine the payment adjustment to the CY 2023 HH PPS rate. CMS is also releasing a data file showing the 30-day periods used to carry out the repricing methodology described in the CY 2023 Home Health Prospective Payment System Rate Update. These supplemental files will include:
- Indicators for which 30-day periods were used to construct 60-day episodes
- OASIS items relevant for grouping 60-day episodes
- Information on visits and minutes of care by discipline during the 60-day episodes and 30-day periods
- Information on payments and payment adjustments (LUPA, PEP, Outliers)
*Please note: Any interested parties who have already purchased the CY 2023 HHA Final Rule LDS file do not have to request access to, or pay for, these supplemental files. Parties will receive these files automatically. Those that have not requested the previously available data will need to submit a DUA to request access to and purchase the LDS file. Access will be granted for both the 30-day LDS file and the supplemental files for the 30-day periods and 60-day episodes used in repricing.
The “Home Health Claims – OASIS” Limited Data Set (LDS) file contains information on the utilization of the Medicare Home Health (HH) benefit. The file is constructed so that each observation represents a particular home health period in a given year. Observations are stripped of most data elements that will permit identification of beneficiaries. Section 51001 of the Bipartisan Budget Act of 2018 (BBA of 2018) included several requirements for home health payment reform. These requirements include the elimination of the use of therapy thresholds for case-mix adjustment and a change from a 60-day unit of payment to a 30-day unit of payment. In the CY 2019 HH PPS final rule with comment period (83 FR 56406), CMS finalized case-mix methodology refinements through the Patient-Driven Groupings Model (PDGM) for home health periods of care beginning on or after January 1, 2020. Beginning in the CY 2022 LDS file, all observations are obtained from actual PDGM claims. Each observation in the file represents a single 30-day period. Information in this file includes:
- Start and end dates of the 30-day periods
- Wage index value associated with each period
- Information regarding the resource use of the period
- HIPPS codes that reflect the case-mix components in the rule that is released along with the file [Note that the HIPPS codes, and other components of this file, may differ from the supplemental files since the supplemental files used case-mix system payment parameters from CY2021]
- Case-mix weights based on the PDGM case-mix methodology of 432 groups
- Indicators for whether the period receives a payment adjustment (LUPA, PEP, outlier)
- Estimated payments for the period that reflect the payment parameters in the rule that is released along with the file
- Information on number and length of visits that occur during the period
- Select information from the Outcome and Assessment Information Set (OASIS) that is used in the payment system.
NOTE: Any given “Home Health Claims – OASIS” file represents a static snapshot of a specific period at the time the data was sourced from NCH. As such, any given record DOES NOT NECESSARILY represent the final coding and/or payment information for that period because if subsequent adjustments to the claims occur after the “Home Health Claims – OASIS” file is completed, they will not be reflected on the file.
The “Home Health Claims – OASIS” LDS file will be updated twice a year. The first update will correspond to annual notices of proposed rulemaking, released in the early summer, and the second update will correspond to the final rule released in the fall. Further information on the variables in the file can be found from:
- The variable layout that accompanies this file under the Downloads section below.
- Visit the Home Health Prospective Payment System Regulations and Notices for current regulations that presents HH PPS rate updates and case-mix adjustment methodology refinements
Media: DVD
Cost: $1,200
Data Format: Comma separated variable block with SAS® read-in program
Available: CY 2021
To browse the record layout, see the Downloads section below.
Please follow the instructions on the DUA - Limited Data Sets page.