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TRICARE Reimbursement Manual 6010.61-M, April 1, 2015
Home Health Care (HHC)
Chapter 12
Addendum B
Home Health Resource Group (HHRG) Worksheet
Revision:  C-46, March 26, 2020
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.)
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