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42 CFR § 484.305
42 CFR § 484.305
Definitions. As used in this subpart—
Applicable measure
Applicable measure means a measure for which a competing HHA has provided a minimum of—
(1)
Twenty home health episodes of care per year for the OASIS-based measures;
(2)
Twenty home health episodes of care per year for the claims-based measures; or
(3)
Forty completed surveys for the HHCAHPS measures.
Applicable percent
Applicable percent means a maximum upward or downward adjustment for a given performance year, not to exceed the following:
(1)
For CY 2018, 3-percent.
(2)
For CY 2019, 5-percent.
(3)
For CY 2020, 6-percent.
(4)
For CY 2021, 7-percent.
Benchmark
Benchmark refers to the mean of the top decile of Medicare-certified HHA performance on the specified quality measure during the baseline period, calculated for each state.
Competing home health agency or agencies
Competing home health agency or agencies means an agency or agencies:
(1)
That has or have a current Medicare certification; and,
(2)
Is or are being paid by CMS for home health care delivered within any of the states specified in § 484.310.
Home health prospective payment system (HH PPS)
Home health prospective payment system (HH PPS) refers to the basis of payment for home health agencies as set forth in §§ 484.200 through 484.245.
Larger-volume cohort
Larger-volume cohort means the group of competing home health agencies within the boundaries of selected states that are participating in HHCAHPs in accordance with § 484.250.
Linear exchange function
Linear exchange function is the means to translate a competing HHA's Total Performance Score into a value-based payment adjustment percentage.
New measures
New measures means those measures to be reported by competing HHAs under the HHVBP Model that are not otherwise reported by Medicare-certified HHAs to CMS and were identified to fill gaps to cover National Quality Strategy Domains not completely covered by existing measures in the home health setting.
Payment adjustment
Payment adjustment means the amount by which a competing HHA's final claim payment amount under the HH PPS is changed in accordance with the methodology described in § 484.325.
Performance period
Performance period means the time period during which data are collected for the purpose of calculating a competing HHA's performance on measures.
Selected state(s)
Selected state(s) means those nine states that were randomly selected to compete/participate in the HHVBP Model via a computer algorithm designed for random selection and identified at § 484.310(b).
Smaller-volume cohort
Smaller-volume cohort means the group of competing home health agencies within the boundaries of selected states that are exempt from participation in HHCAHPs in accordance with § 484.250.
Total Performance Score
Total Performance Score means the numeric score ranging from 0 to 100 awarded to each competing HHA based on its performance under the HHVBP Model.
Value-based purchasing
Value-based purchasing means measuring, reporting, and rewarding excellence in health care delivery that takes into consideration quality, efficiency, and alignment of incentives. Effective health care services and high performing health care providers may be rewarded with improved reputations through public reporting, enhanced payments through differential reimbursements, and increased market share through purchaser, payer, and/or consumer selection.
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