This regulation establishes the payment adjustment methodology for Home Health Agencies (HHAs) participating in the Expanded Home Health Value-Based Purchasing (HHVBP) Model. CMS calculates upward or downward payment adjustments based on each HHA's Total Performance Score relative to other agencies in its cohort, using a linear exchange function. Adjustments are applied as a percentage of otherwise-applicable Medicare home health payments under section 1895 of the Act. This rule governs home health agency reimbursement and does not apply to any behavioral health, IDD, ABA, or foster care facility type.
View official source§ 484.365 Payments for home health services under the Expanded Home Health Value-Based Purchasing (HHVBP) Model. CMS determines a payment adjustment up to the applicable percent, upward or downward, under the expanded HHVBP Model for each competing HHA based on the agency's Total Performance Score using a linear exchange function that includes all other HHAs in its cohort that received a Total Performance Score for the applicable performance year. Payment adjustments made under the expanded HHVBP Model are calculated as a percentage of otherwise-applicable payments for home health services provided under section 1895 of the Act (42 U.S.C. 1395fff).