This regulation defines how CMS calculates the Total Performance Score for competing home health agencies under a value-based purchasing model, weighting performance on OASIS-based, claims-based, and HHCAHPS measures across performance years. It is specific to home health agency payment and quality reporting programs and does not govern any behavioral health, IDD, ABA, or foster care facility type.
View official source§ 484.320 Calculation of the Total Performance Score. A competing home health agency's Total Performance Score for a model year is calculated as follows: (a) CMS will award points to the competing home health agency for performance on each of the applicable measures excluding the New Measures. (b) CMS will award points to the competing home health agency for reporting on each of the New Measures worth up to ten percent of the Total Performance Score. (c)(1) For performance years 1 through 3, CMS will sum all points awarded for each applicable measure excluding the New Measures, weighted equally at the individual measure level to calculate a value worth 90 percent of the Total Performance Score. (2) For performance years 4 and 5, CMS will sum all points awarded for each applicable measure within each category of measures (OASIS-based, claims-based and HHCAHPS) excluding the New Measures, weighted at 35 percent for the OASIS-based measure category, 35 percent for the claims-based measure category, and 30 percent for the HHCAHPS measure category when all three measure categories are reported, to calculate a value worth 90 percent of the Total Performance Score. (d) The sum of the points awarded to a competing HHA for each applicable measure and the points awarded to a competing HHA for reporting data on each New Measure is the competing HHA's Total Performance Score for the calendar year. [80 FR 68718, Nov. 5, 2015, as amended at 81 FR 76796, Nov. 3, 2016; 83 FR 56630, Nov. 13, 2018]