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Home Health Agency (HHA) Center

Spotlights
  • The Centers for Medicare & Medicaid Services (CMS) released a final rule (CMS-3819-F) that modernizes the Home Health Agency Conditions of Participation (CoPs). The final rule, effective July 13, 2017, will improve the quality of health care services for all home health patients and strengthen patients’ rights. The regulation reflects the most current home health agency practices by focusing on the care provided to patients and the impact of that care on patient outcomes. This regulation focuses on assuring the protection and promotion of patient rights; enhances the process for care planning, delivery, and coordination of services; and builds a foundation for ongoing, data-driven, agency-wide quality improvement. These changes are an integral part of CMS’ overall effort to improve the quality of care furnished through the Medicare and Medicaid programs, while streamlining requirements for providers. HHA (CoP) Final Rule (CMS-3819-F) at Federal Register through 1/12/2017

  • MLN Connects® National Provider Call – Home Health Groupings Model Technical Report Call (January 18, 2017)

    This MLN Connects™ National Provider Call will provide an overview of the Home Health Groupings Model (HHGM). This technical report describes efforts to reassess the current HH PPS and develop large-scale payment methodology changes. During this call, CMS experts introduce the HHGM model. A question and answer session follows the presentation. Prior to the call, participants are encouraged to review the technical report. For links to the free registration, visit this MLN Connects® National Provider Call web page.

  • Medicare Home Health Prospective Payment System Case-Mix Methodology Refinements: Overview of the Home Health Groupings Model - Opens in a new window

    This technical report describes efforts to date on reassessing the current Home Health Prospective Payment System (HH PPS) and developing potentially large-scale payment methodology changes to better align payment with patient  needs, to address payment incentives and vulnerabilities in the current system, and to respond to the concerns laid out in the prior Home Health Study Report to Congress, required by section 3131(d) of the Affordable Care Act, and from the Medicare Payment Advisory Commission. The report specifically discusses one potential model called the Home Health Groupings Model. Any questions or comments about this Technical Report should be sent to: HomeHealth@abtassoc.com.

    HHGM ICD-9-CM Codes for Clinical Groupings and Comorbidities [ZIP, 290KB]  

  • The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1648-F) that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2017.  In the CY 2017 final rule, CMS implements the fourth and final year of the four year phase-in of the rebasing adjustments to the HH PPS payment rates as required by the Affordable Care Act.  In addition, CMS will decrease the national, standardized 60-day episode payment amount by 0.97 percent in CY 2017 to account for nominal case-mix growth between CY 2012 and CY 2014, which was not accounted for in the rebasing adjustments finalized in the CY 2014 HH PPS final rule.  CMS is also changing the methodology used to calculate outlier payments to a per-unit approach.  The CY 2017 final rule will result in a 0.7 percent decrease (-$130 million) in payments to HHAs.  

    As required by the Consolidated Appropriations Act, 2016, CMS is implementing a separate payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care.  CMS also provides an update to the Home Health Quality Reporting Program and an update regarding public reporting of performance under the HH VBP Model.

  • Report to Congress on the Medicare Home Health Study: An Investigation on Access to Care and Payment for Vulnerable Patient Populations
    Section 3131(d) of the Affordable Care Act required that CMS conduct a study on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically under served areas, and in treating beneficiaries with varying levels of severity of illness (“vulnerable patient populations”) and submit a report to Congress.  View the report to Congress and Appendix in the links below.

Home Health, Hospice and DME Open Door Forum

Physician Certification of Patient Eligibility for the Medicare Home Health Benefit

  • MLN Matters® SE1436: Certifying Patients 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 Matters® MM8444: Clarification of the Definition of "Confined to the Home"

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