Calculation of Episodes Update for 2011-2012

The National Association for Home Care & Hospice received confirmation from CMS of the following information about the way 2012 home health PPS payment are being calculated.

The change is to the application of case mix weights (#4 below) based on episode ending date rather than M0090 date.

  1. 2012 Average episode payment and LUPA rates are to be applied to episodes that end 1/1/12 through 12/31/12.
  2. 2012 Wage index is applied to episodes that end 1/1/12 and after.
  3. Case mix scoring (i.e. the grouper logic used to score clinical, functional, and service utilization to create the HHRG/HIPPS) is  to be based on the M0090 date. The 2012 revised case-mix scores, which reflect the elimination of the two hypertension codes, go into effect with episodes that have a M0090 date of 1/1/12 and after.
  4. The 2012 case mix weights (i.e. the values assigned to the HHRG/HIPPS) are applied to episodes ending 1/1/12-12/31/12.

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