HHRG
Worksheet Inputs For Home Health Services Beginning On Or After
January 1, 2020
This
appendix describes the components of the Patient-Driven Groupings
Model (PDGM) Grouping worksheet, which can be found in the most
recent PDGM Grouper Tool file found at https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html.
The
following five categories are required in order to determine the
HHRG for each 30-day home health period under PGDM:
• Timing
• Admission
Source
• Clinical
Grouping
• Functional
Impairment Level
• Comorbidity
Adjustment
Timing: Each
30-day period is identified as either Early or Late.
The first 30-day period is classified as early. All subsequent 30-day
periods in the sequence (second or later) are classified as late.
Admission
Source: Each 30-day period is
identified by the admission source (institutional or community)
depending on what healthcare setting was utilized in the 14 days
prior to home health admission. Late 30-day periods are always classified
as a community admission unless there was an acute hospitalization
in the 14 days prior to the late home health 30-day period. A post-acute
stay in the 14 days prior to a late home health 30-day period would
not be classified as an institutional admission unless the patient
had been discharged from home health prior to post-acute stay.
Clinical
Grouping: Each 30-day period
is grouped into one of 12 clinical groups based on the patient’s principal
diagnosis on the claim.
Functional
Impairment Level: Each period
is identified as having either low, medium, or high functional impairment
based on the scores for eight OASIS items.
Comorbidity
Adjustment: A low, high, or
no comorbidity adjustment may be made based on the presence of secondary
diagnoses on the claim.
Figure 12.B-1 Abbreviated
Outcome And Assessment Information Set (OASIS) Questions
|
|
|
(To
be used in conjunction with PDGM Grouping Worksheet for payment
of home health periods beginning on or after January 1, 2020 for
children and maternity cases.)
|
|
|
|
|
|
Figure 12.B-2 HHRG
For 60-DAY Episodes Of
Care Beginning On Or After January 1, 2008
|
|
|
Figure 12.B-3 Abbreviated
OASIS Questions
|
|
|
|
(To be used
in conjunction with Home Health Resource Group (HHRG) Worksheet
for scoring and payment of home health episodes beginning on or
after January 1, 2008 for children and maternity cases.)
|
|
|