[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR484.215]



[Page 591]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 484_HOME HEALTH SERVICES--Table of Contents

 

      Subpart E_Prospective Payment System for Home Health Agencies

 

Sec. 484.215  Initial establishment of the calculation of the national 

60-day episode payment.



    (a) Determining an HHA's costs. In calculating the initial 

unadjusted national 60-day episode payment applicable for a service 

furnished by an HHA using data on the most recent available audited cost 

reports, CMS determines each HHA's costs by summing its allowable costs 

for the period. CMS determines the national mean cost per visit.

    (b) Determining HHA utilization. In calculating the initial 

unadjusted national 60-day episode payment, CMS determines the national 

mean utilization for each of the six disciplines using home health 

claims data.

    (c) Use of the market basket index. CMS uses the HHA market basket 

index to adjust the HHA cost data to reflect cost increases occurring 

between October 1, 1996 through September 30, 2001.

    (d) Calculation of the unadjusted national average prospective 

payment amount for the 60-day episode. CMS calculates the unadjusted 

national 60-day episode payment in the following manner:

    (1) By computing the mean national cost per visit.

    (2) By computing the national mean utilization for each discipline.

    (3) By multiplying the mean national cost per visit by the national 

mean utilization summed in the aggregate for the six disciplines.

    (4) By adding to the amount derived in paragraph (d)(3) of this 

section, amounts for nonroutine medical supplies, an OASIS adjustment 

for estimated ongoing reporting costs, an OASIS adjustment for the one 

time implementation costs associated with assessment scheduling form 

changes and amounts for Part B therapies that could have been unbundled 

to Part B prior to October 1, 2000. The resulting amount is the 

unadjusted national 60-day episode rate.

    (e) Standardization of the data for variation in area wage levels 

and case-mix. CMS standardizes--

    (1) The cost data described in paragraph (a) of this section to 

remove the effects of geographic variation in wage levels and variation 

in case-mix;

    (2) The cost data for geographic variation in wage levels using the 

hospital wage index; and

    (3) The cost data for HHA variation in case-mix using the case-mix 

indices and other data that indicate HHA case-mix.