When a resident is preparing to leave a skilled nursing facility, healthcare professionals use something called the Discharge Function Score to gauge how well they’ll manage on their own. This score is crucial because it helps determine the level of support or care the resident might need after they leave. But how exactly is this score calculated? Let’s break it down in simple terms.

Since the advent of Payroll Based Journal (PBJ) reporting by CMS in 2016, facilities have struggled with preparing and submitting accurate PBJ data. Penalties applied for a failure to submit complete and accurate data can result in defaulting to a one-star rating and negatively impacting overall 5-star ratings.

CMS published the CY 2021 Home Health Payment System Rate final rule on November 4th. As it stands, all of the PDGM methodology, the Behavioral Adjustments level, LUPA thresholds and case-mix weights will be kept the same in CY 2021 as they were in the first year of PDGM. With another quarter of data under our belts and with the better understanding and management of COVID-19, Chris Attaya takes a look at several areas of expected PDGM behavioral changes.

The CY 2019 Home Health Payment System Rate final rule was published last week and, as expected, the Patient-Driven Groupings Model (PDGM) will be implemented for 30-day periods of care starting on or after January 1, 2020. In our blog we provide a summary of changes to the model, such as the expansion of clinical groups from six to twelve, as well as home health PPS Case-mix updates and significant HHVBP changes confirmed in the final rule.

In the CY 2019 Home Health Proposed Rule, CMS shared a level of detail not seen before – an agency specific list of how agencies will fare under the changes they are proposing. Wow. CMS shared the agency revenue impacts of the Patient-Driven Groupings Model (PDGM) versus the current 153-group PPS reimbursement revenue. The range of the revenue impact is quite wide. Looking at the SHP national database for CY 2017, about 17% of the 3.6MM payment episodes in our database had a primary diagnosis code that would be considered a QE under PDGM.

July usually starts the month off with fireworks, but this year the proposed rule was issued on July 2nd with its own bang at just under 600 pages. The big news - Home Health Groupings Model (HHGM) is now the Patient-Driven Groupings Model (PDGM). Below are a few other highlights from the proposed rule related to the Home Health Value Based Purchasing (HHVBP) program, Home Health Quality Reporting Program (HHQRP), new Home Infusion Benefit and the changing HH PPS case-mix weights (CMW).

On February 28th CMS ended the month hosting their regular Home Health Open Door Forum with some very notable updates to the home care industry. With little fanfare and during the Q&A portion, CMS responded to a question regarding the timing of the new OASIS forms as OASIS-D!

The big news in the latest proposed rule for HH PPS was the Home Health Groupings Model (HHGM). Along with the typical recalibration to case-mix payments and case weights, did you see the significant proposals regarding the Home Health Quality Reporting Program (HH QRP)? Almost a third of the 389 pages in the rule were in regard to the HH QRP.

On January 18th, CMS presented a slideshow through their Medicare Learnings Network on a possible new payment refinement to home health care reimbursement called the Home Health Groupings Model (HHGM). This was the second call in six months where Abt Associates, CMS’ contractor, shared the HHGM background in addition to the 178 page technical report they issued in November 2016. This sure seems to be picking up speed.

CMS issued the Final CY 2017 Home Health PPS Rate Update in the Federal Register on November 3rd. All of the proposals to update the VBP program were finalized with no changes regardless of stakeholder comments, except for one...

With provider and industry comments now in, the Centers for Medicare and Medicaid Services (CMS) will take the next 60 days to evaluate and make any suggested changes in the Home Health CY 2017 Final Rule.

CMS made the Star Rating Preview Reports available within the last two weeks. Where does your agency fall in the ratings?

CMS is introducing new reports as an educational tool for Home Health Care in July 2015.

The Home Health Proposed Rule was posted by CMS on the Federal Register July 10th and it was full of surprises, especially in light of the much anticipated proposal on Value Based Purchasing (VBP).

CMS has put its final stamp of approval on the Hospice Item Set (HIS). Now you need to get your hospice ready. Here’s how.

Despite double warnings, late recerts continue to be an issue. Why do they matter and what can you do about it?

We think the new measure is more favorable to home health and strikes a nice balance between emulating the hospital measure and giving agencies an accurate evaluation of their performance.

I'm interested in learning how your agency has responded to the change.

We're pleased to announce that the SHP Real-time Home Health Compare report will be right in synch with the CMS changes.

Although many agencies initially fought OASIS, most would be reluctant to give it up today and lose the valuable clinical insights gained through its use.

This dilemma paints agencies into a corner, and they answer 'no' to M1910 on OASIS, thus resulting in poor public scores.

Robin Dowell, Office of Clinical Standards at CMS, responded to our letter asking for guidance on the fall risk assessment dilemma this morning.