[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: 42CFR484.237]



[Page 592-593]

 

                         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. 484.237  Methodology used for the calculation of the significant 

change in condition payment adjustment.



    (a) CMS makes a SCIC payment adjustment to the original 60-day 

episode payment that is interrupted by the intervening event defined in 

Sec. 484.205(e).

    (b) The SCIC payment adjustment is calculated in two parts.

    (1) The first part of the SCIC payment adjustment reflects the 

adjustment to the level of payment prior to the significant change in 

the patient's condition during the 60-day episode. The first part of the 

SCIC adjustment is determined by taking the span of days (the first 

billable visit date through and including the last billable visit date) 

prior to the patient's significant change in condition as a proportion 

of 60 multiplied by the original episode amount.

    (2) The second part of the SCIC payment adjustment reflects the 

adjustment to the level of payment after the significant change in the 

patient's condition occurs during the 60-day episode. The second part of 

the SCIC adjustment is calculated by using the span of days (the first 

billable visit date through and including the last billable visit date) 

through the balance of the 60-day episode.

    (c) The initial percentage payment provided at the start of the 60-

day episode will be adjusted at the end of the episode to reflect the 

first and second



[[Page 593]]



parts of the total SCIC adjustment determined at the end of the 60-day 

episode.