MLN Product (Revised): Medicare Home Health Benefit
Summary This revised Product comprises Subregulatory Guidance for the Home Health Prospective Payment System (HH PPS), and its content is based on publically available content within Section 1895 of the Social Security Act at https://www.ssa.gov/OP_Home/ssact/title18/1895.htm, Section 1861(m) of the Social Security Act at https://www.ssa.gov/OP_Home/ssact/title18/1861.htm#act-1861-m, Section 5012 of the 21st Century Cures Act at https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf and CY 2021 Home Health PPS final rule at https://www.govinfo.gov/content/pkg/FR-2020-11-04/pdf/2020-24146.pdf. CMS policy or operation subject matter experts also reviewed/cleared this product. This product educates home health providers about consolidated billing (CB) requirements, elements of the HH PPS, case mix and other payment adjustments, updates to the HH PPS and physician and allowed practitioner billing and payment for home health services. Revisions to this Product include following content updates:
• added Medicare will pay all Home Health Agencies (HHAs) a 0% split-percentage payment (page 3);
• added beginning in CY 2022, HHAs will no longer submit a no pay request for anticipated payment (RAP) (page 3);
• added the Low Utilization Payment Adjustment (LUPA) threshold changed to a variable threshold (page 6);
• added HHAs may use telecommunications technologies to care for patients (page 6);
• added Home infusion therapy services is excluded from the definition of home health services (page 7); and
• added HHAs must report data using Outcome and Assessment Information Set (OASIS) and Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) (page 8).
The previous version of this Product is available to the public and currently posted on the CMS website at: https://www.cms.gov/files/document/home-health-prospective-payment-system.pdf.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 24, 2021
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.