This regulation limits the appeal rights of Home Health Agencies (HHAs) under the Medicare prospective payment system, specifying that HHAs have no entitlement to judicial or administrative review regarding payment unit establishment, 60-day episode payment rates, outlier adjustments, transition periods, and case-mix or area wage adjustment factors. It is a Medicare payment policy rule governing home health reimbursement methodology, not a behavioral health, IDD, ABA, or foster care facility licensing or operating standard.
View official source§ 484.260 Limitation on review. An HHA is not entitled to judicial or administrative review under sections 1869 or 1878 of the Act, or otherwise, with regard to the establishment of the payment unit, including the national 60-day prospective episode payment rate, adjustments and outlier payments. An HHA is not entitled to the review regarding the establishment of the transition period, definition and application of the unit of payments, the computation of initial standard prospective payment amounts, the establishment of the adjustment for outliers, and the establishment of case-mix and area wage adjustment factors.