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
CMS is implementing significant changes that will affect payment for home health services beginning in CY 2020 and for skilled nursing facilities (SNFs) beginning in FY 2019. Included are the new Patient-Driven Groupings Model (PGPM) in home health and the Patient-Driven Payment Model (PDPM) in skilled nursing facilities. APTA's webpage of resources on these models includes a recorded "myth-busting" webinar on the PDPM and PDGM, and background on both models with links to further information and explanation.
Review Choice Demonstration
December 10, 2018: CMS initially announced in September that it would begin the Review Choice Demonstration in Illinois on December 10, 2018. It updated the announcement on December 10, saying that the Paperwork Reduction Act (PRA) approval process for the demonstration was still ongoing, and once approval is received, the agency will update its website with a start date for home health agencies in Illinois and instructions on the choice selection process. CMS will continue to post additional information on its Review Choice Demonstration for Home Health Services webpage, to include notice about phasing in the other demonstration states: Ohio, North Carolina, Florida, and Texas.
May 31, 2018: CMS issued a notice indicating its intention to re-launch a home health agency (HHA) pre-claim review demonstration project it had shelved in 2017. Now called the Review Choice Demonstration for Home Health Services, the revised demonstration will begin no earlier than October 1, 2018, in 5 states. The original program had drawn criticism that it created significant administrative burdens and reduced access to care. The revised Review Choice Demonstration will give HHAs in the demonstration states 3 options: pre-claim review of all claims, postpayment review of all claims, or minimal postpayment review with a 25% payment reduction for all home health services. The demonstration initially will apply to HHA providers in Florida, Illinois, North Carolina, Ohio, and Texas, with the option to expand after 5 years to other states in the Medicare Administrative Contractor Jurisdiction M (Palmetto).
Learn more about the Review Choice Demonstration: