Military Health System

This Addendum 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: 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 calendar 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 calendar days prior to the late home health 30-day period. A post-acute stay in the 14 calendar 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.