Expanded Home Health Value-Based Purchasing Model

CY 2023 Home Health Prospective Payment System final rule: Available for viewing and download on the Federal Register.

Pre-Implementation Performance Reports (PIPR) Available in iQIES. Instructions on how to access your HHA’s November 2022 PIPR as well as an on-demand recording and written resource describing the PIPR are available below, under Model Reports. 

Building upon experience from the original Home Health Value-Based Purchasing Model (HHVBP Model), this page provides information, resources, and technical assistance to support implementation of the expanded HHVBP Model nationwide.

Have questions about the expanded HHVBP Model? Please send questions to HHVBPquestions@lewin.com. Be sure to include your name and the home health agency’s name and CCN.

Background

As authorized by section 1115A of the Act and finalized in the Calendar Year (CY) 2016 Home Health Prospective Payment System (HH PPS) final rule (80 FR 68624), the Center for Medicare and Medicaid Innovation (Innovation Center) implemented the Home Health Value-Based Purchasing (HHVBP) Model (“original Model”) in nine (9) states on January 1, 2016. The design of the original HHVBP Model leveraged the successes and lessons learned from other CMS 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 specific goals of the original HHVBP Model were 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.

The original HHVBP Model resulted in an average 4.6 percent improvement in HHAs' total performance scores (TPS) and an average annual savings of $141 million to Medicare without evidence of adverse risks. The evaluation of the original model also found reductions in unplanned acute care hospitalizations and skilled nursing facility (SNF) stays, resulting in reductions in inpatient and SNF spending. The U.S. Secretary of Health and Human Services determined that expansion of the original HHVBP Model would further reduce Medicare spending and improve the quality of care. In October 2020, the CMS Chief Actuary certified that expansion of the HHVBP Model would produce Medicare savings if expanded to all states.

On January 8, 2021, CMS announced the certification of the HHVBP Model for expansion nationwide, as well as the intent to expand the Model through notice and comment rulemaking. On July 7, 2021, CMS published the proposed rule for public comment.

On November 2, 2021, CMS published the CY 2022 HH PPS final rule establishing the end of the original model and the start of the expanded Model. The final rule also established HHA eligibility criteria, payment adjustment rates, definition of cohorts, applicable quality measures, and payment methodology. The final rule appears in the November 2, 2021 Federal Register.

On October 31, 2022, the CY 2023 HH PPS final rule amended the HHA baseline year, and the Model baseline year from CY 2019 to CY 2022 starting in the CY 2023 performance year to enable CMS to measure competing HHAs performance on benchmarks and achievement thresholds that are more current. The final rule appears in the October 31, 2022 Federal Register.

The Expanded HHVBP Model

The expanded HHVBP Model begins on January 1, 2022 and includes Medicare-certified HHAs in all fifty (50) states, District of Columbia, and the U.S. territories. Calendar Year (CY) 2022 is the pre-implementation year.

During CY 2022, CMS will provide HHAs with resources and training. This will allow HHAs time to prepare and learn about the expectations and requirements of the expanded HHVBP Model without risk to payments. The first full performance year for the expanded HHVBP Model is CY 2023, beginning January 1, 2023. Calendar Year 2025 will be the first payment year, with payment adjustment amounts determined on CY 2023 performance.

hhvbp timeline graphic test

Model Details

Under the expanded HHVBP Model, HHAs receive adjustments to their Medicare fee-for-service payments based on their performance against a set of quality measures, relative to their peers’ performance. Performance on these quality measures in a specified year (performance year) impacts payment adjustments in a later year (payment year).

Data from Outcome and Assessment Information Set (OASIS), completed Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) surveys and, claims-based measures are used to calculate HHAs’ performance. In a payment year, an applicable percent ranging from -5% to 5% is applied toward Medicare fee-for-service payments.

In the expanded Model, cohorts are determined based on each HHA’s unique beneficiary count in the prior Calendar Year. HHAs are assigned to either a nationwide larger-volume cohort or nationwide smaller-volume cohort to group HHAs that are of similar size and are more likely to receive scores on the same set of measures for purposes of setting benchmarks and achievement thresholds and determining payment adjustments.

Data Source and Measures

OASIS-based

  • Improvement in Dyspnea/Dyspnea
  • Discharged to Community
  • Improvement in Management of Oral Medications/Oral Medications
  • Total Normalized Composite Change in Self-Care/TNC Self-Care
  • Total Normalized Composite Change in Mobility/TNC Mobility

Claims-based

  • Acute Care Hospitalization During the First 60 Days of Home Health Use/ACH
  • Emergency Department Use without Hospitalization During the First 60 Days of Home Health/ED Use

HHCAHPS Survey-based

  • Care of Patients/Professional Care
  • Communications between Providers and Patients/Communication
  • Specific Care Issues/Team Discussion
  • Overall rating of home health care/Overall Rating
  • Willingness to recommend the agency/Willing to Recommend

HHVBP Resources

Expanded HHVBP Model YouTube Playlist

Model Overview

FAQs & Model Guide

Model Reports

Newsletters

Quality Measures

Quality Improvement

Total Performance Score & Payment Adjustment

Regulations & Notices

Additional Information

Outreach

If you are interested in receiving additional information, updates or have questions about the Expanded Home Health Value-Based Purchasing Model, please engage with the below resources:

 

 

Last updated on:
11/23/2022