Home Health Value-Based Purchasing Model

For information about the Expanded HHVBP Model finalized in the CY 2022 Home Health Prospective Payment System rule, please click here.

The Center for Medicare and Medicaid Innovation (Innovation Center) implemented the original Home Health Value-Based Purchasing (HHVBP) Model from January 1, 2016 through December 31, 2021. The model was designed to support greater quality and efficiency of care among Medicare-certified Home Health Agencies (HHA) across the nation. The HHVBP Model supported 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 Home Health Prospective Payment System (HH PPS) final rule, the original HHVBP Model leveraged 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 was 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 public reporting process.

Initiative Details

The original HHVBP Model was implemented in nine states representing each geographic area in the nation. All Medicare-certified HHAs that provided services in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee competed on value, where payment was tied to quality performance. HHAs in the nine states had 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.

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

On January 8, 2021, CMS announced intent to expand the HHVBP Model.  The HHVBP Model was expanded nationwide in the final CY 2022 HH PPS rule.  In addition, the CY 2022 HH PPS final rule finalized to end the HHVBP Model one year early for the HHAs in the nine original Model states, such that CY 2020 performance data will not be used to calculate a payment adjustment for HHAs in the nine states and will not have their payments impacted in CY 2022.  Refer to the link for the CY 2022 HH PPS final rule for more information.

Evaluations

Latest Evaluation Reports

Prior Evaluation Reports

Additional Information

Last updated on:
01/10/2022