TRICARE Reimbursement Manual 6010.61-M, April 1, 2015 Chapter 12 Home Health Care (HHC) Revision: C-58, April 20, 2021 Section/Addendum Subject/Addendum Title 1 Home Health Benefit Coverage And Reimbursement - General Overview 2 Home Health Care (HHC) - Benefits And Conditions For Coverage Figure 12.2-1 Copayments/Cost-Shares For Services Reimbursed Outside The HHA PPS When Receiving Home Health Services Under A POC For Services Received Before January 1, 2018 3 Home Health Benefit Coverage And Reimbursement - Assessment Process 4 Home Health Benefit Coverage And Reimbursement - Prospective Payment Methodology Figure 12.4-1 Calculating Domain Scores From Response Values Figure 12.4-2 Clinical Severity Domain Figure 12.4-3 Functional Status Domain Figure 12.4-4 Service Utilization Domain Figure 12.4-5 HHRG To HIPPS Code Crosswalk Figure 12.4-6 New HIPPS Code Structure Under HH PPS Case-Mix Refinement Figure 12.4-7 Scoring Matrix For Constructing HIPPS Code Figure 12.4-8 Case-Mix Adjustment Variables And Scores For Episodes Ending Before January 1, 2012 Figure 12.4-9 Case-Mix Adjustment Variables And Scores For Episodes Ending On Or After January 1, 2012 Figure 12.4-10 Relative Weights For NRS - Six-Group Approach Figure 12.4-11 NRS Case-Mix Adjustment Variables And Scores Figure 12.4-12 Format For Treatment Authorization Code Figure 12.4-13 Converting Point Values To Letter Codes Figure 12.4-14 Example Of A Treatment Authorization Code Figure 12.4-15 Calculation Of National 60-day Episode Payment Amounts Figure 12.4-16 Standardization For Case-Mix And Wage Index 5 Home Health Benefit Coverage And Reimbursement - Primary Provider Status And Episodes/Periods Of Care 6 Home Health Benefit Coverage And Reimbursement - Claims And Billing Submission Under Home Health Agency Prospective Payment System (HHA PPS) 7 Home Health Benefit Coverage And Reimbursement - Pricer Requirements And Logic 8 Home Health Benefit Coverage And Reimbursement - Medical Review Requirements 9 Home Health Benefit Coverage And Reimbursement - Under The Patient-Driven Groupings Model (PDGM) A Definitions And Acronym Table B Home Health Resource Group (HHRG) Worksheet Figure 12.B-1 Abbreviated Outcome And Assessment Information Set (OASIS) Questions 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 C (CY 2019) Annual Home Health Agency Prospective Payment System (HHA PPS) Rate Updates - CY 2019 Figure 12.C.2019-1 CY 2019 National Standardized 60-Day Episode Payment Amounts Figure 12.C.2019-2 CY 2019 National Per-Visit Payment Amounts For HHAs Figure 12.C.2019-3 CY 2019 NRS Conversion Factor Figure 12.C.2019-4 CY 2019 Relative Weights For The Six-Severity NRS System Figure 12.C.2019-5 CY 2019 Cost-Per-Unit Payment Rates For The Calculation Of Outlier Payments Figure 12.C.2019-6 CY 2019 Rural Add-On Percentages By Category C (CY 2020) Annual Home Health Agency Prospective Payment System (HHA PPS) Rate Updates - CY 2020 Figure 12.C.2020-1 CY 2020 National Standardized 60-Day Episode Payment Amounts Figure 12.C.2020-2 CY 2020 National Standardized 30-Day Period Payment Amounts Figure 12.C.2020-3 CY 2020 National Per-Visit Payment Amounts For HHAs Figure 12.C.2020-4 CY 2020 NRS Conversion Factor Figure 12.C.2020-5 CY 2020 Relative Weights For The Six-Severity NRS System Figure 12.C.2020-6 CY 2020 Cost-Per-Unit Payment Rates For The Calculation Of Outlier Payments Figure 12.C.2020-7 CY 2020 Rural Add-On Percentages By Category C (CY 2021) Annual Home Health Agency Prospective Payment System (HHA PPS) Rate Updates - CY 2021 Figure 12.C.2021-1 CY 2021 National Standardized 30-Day Period Payment Amounts Figure 12.C.2021-2 CY 2021 National Per-Visit Payment Amounts For HHAs Figure 12.C.2021-3 CY 2021 Cost-Per-Unit Payment Rates For The Calculation Of Outlier Payments Figure 12.C.2021-4 CY 2021 Rural Add-On Percentages By Category D Home Health Certification And Plan Of Care (POC) E Code Table For Converting Julian Dates To Two Position Alphabetic Values