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Medicare: Centers for Medicare and Medicaid Services (CMS) upcoming changes for Home Health Care (HHC) beginning January 1, 2020


The Patient-Driven Groupings Model (PDGM) case-mix methodology refinements for home health care services will begin on or after January 1, 2020. The refinements include the elimination of therapy thresholds for payment and a change in the unit of payment from a 60-day episode to a 30-day period.
 

CMS is finalizing the split-percentage proposal with an effective date of January 1, 2020. Note the following:

 

  • Newly enrolled Home Health Agencies (HHAs), certified for participation in Medicare effective on or after January 1, 2019, would not receive RAPs (requests for anticipated payments) beginning in CY 2020. HHAs that are certified for participation in Medicare effective on or after January 1, 2019, would still be required to submit a ‘‘no pay’’ RAP at the beginning of care (to establish the home health period of care) as well as every 30 days thereafter.
  • Existing HHAs, meaning those HHAs that are certified for participation in Medicare effective prior to January 1, 2019, will continue to receive RAP payments upon implementation of the PDGM in CY 2020.1

More information

See MLN Matters, Home Health (HH) Patient-Driven Groupings Model (PDGM).
See MLN Matters, Home Health Patient-Driven Groupings Model (PDGM) — Split Implementation
See CMS Manual System, Medicare Claims Processing, Home Health (HH) Patient-Driven Groupings Model (PDGM) — Split Implementation

1Department of Health and Human Services, Centers for Medicare & Medicaid Services. Final Rule. Federal Register. November 13, 2018; 83 (219).