This section defines terms used in the Medicare Home Health Prospective Payment System, including case-mix index, home health disciplines, NPWT, HHCAHPS, HH QRP, and geographic area classifications. It is specific to home health agency payment and quality reporting under Medicare and does not govern any behavioral health, IDD, ABA, or foster care facility type.
View official source§ 484.202 Definitions. As used in this subpart— Case-mix index means a scale that measures the relative difference in resource intensity among different groups in the clinical model. Discipline means one of the six home health disciplines covered under the Medicare home health benefit (skilled nursing services, home health aide services, physical therapy services, occupational therapy services, speech- language pathology services, and medical social services). Furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device means the device is paid separately (specified by the assigned CPT® code) and does not include payment for the professional services. The nursing and therapy services are to be included as part of the payment under the home health prospective payment system. HHCAHPS stands for Home Health Care Consumer Assessment of Healthcare Providers and Systems. HH QRP stands for Home Health Quality Reporting Program. Home health market basket index means an index that reflects changes over time in the prices of an appropriate mix of goods and services included in home health services. Rural area means an area defined in § 412.64(b)(1)(ii)(C) of this chapter. Urban area means an area defined in § 412.64(b)(1)(ii)(A) and (B) of this chapter. [70 FR 68142, Nov. 9, 2005, as amended at 81 FR 76796, Nov. 3, 2016; 83 FR 56628, Nov. 13, 2018; 84 FR 60644, Nov. 8, 2019; 88 FR 77878, Nov. 13, 2023]