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
Patient-Driven Groupings Model
The Centers for Medicare and Medicaid Services (CMS) is implementing significant changes that will affect payment for home health services beginning January 1, 2020. The Patient-Driven Groupings Model (PDGM) is designed to align payment with patient characteristics and needs, and eliminate the connection between therapy utilization and reimbursement. Learn more on APTA's webpage of resources on PDGM and on a similar new model for skilled nursing facilities, the Patient-Driven Payment Model (PDPM). Resources include recorded webinars on the PDGM and PDPM, and background on both models with links to further information and explanation.
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: