Home Health Value-Based Purchasing Model

Effective January 1, 2016, The Centers for Medicare & Medicaid Innovation (CMS Innovation Center) implemented the Home Health Value-Based Purchasing (HHVBP) Model. This new model is designed to support greater quality and efficiency of care among Medicare-certified Home Health Agencies (HHA) across the nation. The HHVBP Model supports the Department of Health and Human Services’ efforts to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.

Background

Authorized by section 1115A of the Act and finalized in the CY 2016 HH PPS final rule, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) implemented the HHVBP Model on January 1, 2016.  The HHVBP Model leverages the successes of and lessons learned from other value-based purchasing programs and demonstrations to shift from volume-based payments to a model designed to promote the delivery of higher quality care to Medicare beneficiaries. The overall purpose of the HHVBP Model is to improve the quality and delivery of home health care services to Medicare beneficiaries with specific goals to: 

  1. Provide incentives for better quality care with greater efficiency;
  2. study new potential quality and efficiency measures for appropriateness in the home health setting; and,
  3. enhance the current public reporting process.

Initiative Details

Effective January 1, 2016, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) implemented the HHVBP Model among all home health agencies (HHAs) in nine states representing each geographic area in the nation. All Medicare-certified HHAs that provide services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will compete on value in the HHVBP model, where payment is tied to quality performance. HHAs in these nine states will have their payments adjusted in the following manner: 

  • a maximum payment adjustment of 3 percent (upward or downward) in 2018, 
  • a maximum payment adjustment of 5 percent (upward or downward) in 2019, 
  • a maximum payment adjustment of 6 percent (upward or downward) in 2020, 
  • a maximum payment adjustment of 7 percent (upward or downward) in 2021, and 
  • a maximum payment adjustment of 8 percent (upward or downward) in 2022.

This model is designed so there is no selection bias, participants are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified HHAs nationally.

For questions please call the helpdesk at (844) 280-5628 or email HHVBPquestions@cms.hhs.gov.

Participant Next Steps

All HHAs included in the HHVBP Model are encouraged to take the following steps:

  1. Establish your Agency's HHVBP Point of Contact: HHAs in the nine selected states should provide the HHVBP Help Desk, HHVBPquestions@cms.hhs.gov, with the name and email address of a primary point of contact for each CMS Certification Number (CCN). Please also include the Agency name, Agency address and Agency phone number.
  2. Obtain a User Account on the CMS Secure Portal: This is an important first step towards registration for the HHVBP Model portal where HHAs will receive performance reports and enter data for new measures.
  3. Obtain a User Account on HHVBP Connect: Access to HHVBP Connect will allow participants to find the latest updates for the HHVBP Model; download valuable resources to help you succeed in the Model; view upcoming HHVBP events and key Model milestones; view the “2015 Benchmarks and Achievement Thresholds”; obtain the updated Frequently Asked Questions (FAQs); view past webinars and register for future webinars; share best practices and chat with your colleagues in the nine Model states; and, understand when to submit New Measures data to the HHVBP Secure Portal as well as when and how to retrieve performance reports.

The Calendar Year (CY) 2017 Home Health Prospective Payment System Proposed Rule comment period began June 27, 2016 and ended August 26, 2016.

Additional Information