This regulation establishes the methodology for calculating and applying value-based payment adjustments to home health agencies (HHAs) participating in the Expanded Home Health Value-Based Purchasing (HHVBP) Model. HHAs are ranked within volume-based cohorts nationwide, and payment adjustments are determined by multiplying the prospective payment claim amount by a payment adjustment percentage derived from the agency's Total Performance Score, the applicable percent, and a linear exchange function slope. This rule governs home health agency reimbursement under Medicare and does not apply to any behavioral health, IDD, ABA, or foster care facility type.
View official source§ 484.370 Process for determining and applying the value-based payment adjustment under the Expanded Home Health Value-Based Purchasing (HHVBP) Model. (a) General. Competing home health agencies are ranked within the larger-volume and smaller-volume cohorts nationwide based on the performance standards in this part that apply to the expanded HHVBP Model, and CMS makes value-based payment adjustments to the competing HHAs as specified in this section. (b) Calculation of the value-based payment adjustment amount. The value-based payment adjustment amount is calculated by multiplying the home health prospective payment final claim payment amount as calculated in accordance with § 484.205 by the payment adjustment percentage. (c) Calculation of the payment adjustment percentage. The payment adjustment percentage is calculated as the product of all of the following: (1) The applicable percent as defined in § 484.345. (2) The competing HHA's Total Performance Score divided by 100. (3) The linear exchange function slope. [86 FR 62422, Nov. 9, 2021, as amended at 87 FR 66887, Nov. 4, 2022]