Information and resources on Medicare payment and policies in the home health setting. If you have questions about this information, contact firstname.lastname@example.org.
News and Updates
October 2, 2019:
Where Things Stand, What APTA's Doing: Fee Schedule, SNF, and HH Rules From CMS
Learn where things stand with CMS rulemaking, and what is APTA doing around the PFS and other developments. Here's a guide to 3 of the biggest rules issued to date in 2019, along with information on our advocacy efforts.
Patient-Driven Groupings Model
As part of overall efforts to move Medicare payment away from fee for service and toward a structure that holds providers accountable for patient outcomes and costs, the Centers for Medicare and Medicaid Services (CMS) has made significant changes to the home health and skilled nursing facility (SNF) payment systems. The SNF Patient-Driven Payment Model (PDPM) began October 1 (the start of fiscal year 2020), and the Home Health Patient-Driven Groupings Model (PDGM) begins January 1, 2020. Learn more about these new payment models.
Review Choice Demonstration
The Review Choice Demonstration gives participating home health agencies (HHAs) 3 options for claim review: preclaim review of all claims, postpayment review of all claims, or minimal postpayment review with a 25% payment reduction for all home health services. CMS identified 5 states for staggered participation—Illinois, Florida, North Carolina, Ohio, and Texas—with the option to expand after 5 years to other states in the Medicare Administrative Contractor Jurisdiction M (Palmetto).
Illinois is the first state CMS has chosen to participate in the Review Choice Demonstration, beginning June 1, 2019. HHAs in Illinois have until May 16, 2019, to choose 1 of the 3 options, which will impact all episodes of care starting on or after June 1. CMS will provide at least 60 days' notice before beginning the demonstration in any of the 4 additional states. Updates will be posted to the CMS Review Choice Demonstration for Home Health Services webpage, and questions may be sent to homehealthRCD@cms.hhs.gov.
Learn more about the Review Choice Demonstration: