This calendar schedule will help determine the 60th day from the start of care (SOC) date. One of the most important changes between CMS and PPS and PDGM was the change from a 60-day period to two 30-day pay periods and the introduction of early and late episodes in the calculation of payments. Previously, an episode of Start of Care lasted 60 full days. If the patient needed ongoing home care, the agency could re-certify the patient and continue.
The fact is that home health episodes are still 60-day episodes. The 60-day episodes were interrupted because many agencies discharged for the first 30 days of care, but continued to charge the full 60-day payment. CMS noticed and divided the 60 days into two 30-day billing periods. Since 2000, HHA have been paid through a prospective payment system (the HH PPS).).
Currently, HH PPS includes a 60-day care episode that includes all home health services. The payment for each episode of care is adjusted depending on the variety of cases and the wage difference by area. The patients served receive higher payments if certain treatment volume thresholds are reached during the 60 days. The HH PPS also has an adjustment for low utilization payment (LUPA), which reduces the payment for an episode of care that consists of four or fewer visits.
At the beginning of each care episode, HHA files a request for prepayment (RAP) and receives approximately half of the total payment per episode of care in advance. HHA receives the rest of the payment after filing a claim at the end of 60 days. For people with a home health care plan, basic HH PPS payment rates include payment for all services (nursing, therapy, home health aides, and medical social services) and routine and non-routine medical supplies, with the exception of certain injectable osteoporosis medications, DME, and the provision of negative pressure wound therapy (NPWT) with a disposable device. Therefore, for this analysis, the conceptual definition of a new episode was that the customer had not been receiving HHA services for the previous 60 days. In addition, section 3707 of the CARES Act encouraged the use of telecommunications systems for home health services provided during the public health emergency (PHE) caused by COVID-19. The purpose of this analysis was to systematically quantify the characteristics of Medicare home health care clients, the parameters of a total episode of care, and the bivariate associations that might exist between client characteristics and components of care.
Atypical costs will be charged to each period of care by applying the standard amounts per visit to the number of disciplinary visits (specialized nursing visits or physical therapy, speech-language pathology, occupational therapy or home health care services) reported in the claims. Several factors contribute to the recent growing interest in understanding the role of home health care in the range of services for Medicare beneficiaries. While payment is adjusted for each 30-day care period to reflect the health conditions and care needs of the beneficiary, there is a special atypical provision to ensure adequate payment for beneficiaries who have the most expensive care needs. The data for this analysis was obtained in 1987 from a sample of Medicare-certified HHAs that the Health Care Financing Administration (HCFA) had hired in 1985 to participate in a prospective demonstration of HHA payments that had not been implemented at the time. In response, the CMS amended § 409.43 (a), allowing the use of telecommunications technology to be included as part of the home health care plan, provided that the use of such technology does not replace the in-person visit ordered in the care plan.
For each client admitted to the HHA care center, HCFA forms 485 and 486 are filled out to establish the home medical need and document treatment plans and other aspects of the case. The Balanced Budget Act (BBA) of 1997, as amended by the Consolidated and Emergency Supplemental Allocations Omnibus Act (OCESAA) of 1999, required the development and implementation of a prospective payment system (PPS) for Medicare home health services. The implications for case combination models and the implications for capitation payments within the framework of health system reform are discussed. Here you'll find articles from the Health Care Financing Review, courtesy of the Centers for Medicare and Medicaid Services.
Treatment plans for each 60-day period starting from the initial “end date” indicated on the HCFA 485 form are recorded in a series of HCFA forms 486 for each customer. For nearly three-quarters of the conditionally eligible clients (72 percent; n = 2,615 unweighted customers), the start date of the episode so defined was identical to the “start date” of HCFA Form 485; and for another 7 percent (n = 25 unweighted), the start date of the episode was within 5 days of the date “from the start date of HCFA Form 485”. Starting in October 2000, HHAs were paid under HH PPS for 60-day episodes of care that included all covered home health services.
