MLN Product (Revised): Medicare Home Health Benefit

This revised Product comprises Subregulatory Guidance for Medicare home health benefit, and its content is based on publically available content within Medicare Benefit Policy Manual Chapter 7 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf and March 2020 COVID-19 Interim Final Rule at https://www.federalregister.gov/documents/2020/05/08/2020-09608/medicare-and-medicaid-programs-basic-health-program-and-exchanges-additional-policy-and-regulatory. CMS policy or operation subject matter experts also reviewed/cleared this product.
This product educates home health providers about patient qualifications and eligibility for home health services, allowed practitioners, face-to-face encounters, recertification, the Patient-Driven Groupings Model (PDGM) and covered services under the home health benefit. Revisions to this Product include following content updates:
o added Allowed Practitioners, PDGM and Covered Home Health Services sections (pages 2,4,5);
o added Physicians and allowed Non-Physician Practitioners (NPPs) may conduct the required face-to-face encounter via telehealth when the patient is at home (page 3); and
o added that the Low Utilization Payment Adjustment (LUPA) threshold changed to a variable threshold (page 5).
PDGM is a case-mix adjustment payment model effective for home health periods of care beginning on or after January 1, 2020. Medicare pays HHAs a national, standardized rate based on a 30-day period of care. Medicare makes a LUPA payment for 30-day periods where the number of visits is below the case-mix group’s threshold. The previous version of this Product is available to the public and currently posted on the CMS website at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Health-Benefit-Fact-Sheet-ICN908143.pdf.

Download the Guidance Document