The Medicare Learning Network (MLN) has scheduled a call for Feb. 12, 2019, to cover the Patient-Driven Groupings Model that will be implemented Jan. 1, 2020. The PDGM is a case-mix adjustment methodology that will adjust home health payments, based on patient characteristics for 30-day periods of care, to home health agencies providing home health services under Medicare fee-for-service.
PDGM is fully detailed in CMS-1689-F, and results in a 2.2 percent increase ($420 million) in payments to HHAs in CY 2019 and finalizes the methodology used to determine the rural add-on payment for CYs 2019 through 2022 as well as regulations text changes regarding certifying and recertifying patient eligibility for Medicare home health services and remote patient monitoring, according to the Centers for Medicare & Medicaid Services (CMS).
The Feb. 12 MLN call will provide an overview of the PDGM model and walk through payment adjustments, including low utilization payment adjustments, partial payment adjustments and outliers payments. A question and answer session will follow the presentation. The call is geared toward home health agencies, administrators, clinicians and other interested stakeholders.
To further assist Medicare home health agencies in moving to the new payment model, the National Association for Home Care & Hospice (NAHC) will begin a national education program and stakeholder meet-up at designated locations around the U.S.
PDGM is expected to significantly impact virtually all aspects of payment methodology, and significant operational and organizational reforms must be undertaken by agencies in early 2019 to successfully transition to PDGM, according to NAHC. The series of intensive one-day summits are being developed in partnership with state associations, the Home Care and Hospice Financial Managers Association, and the Home Care Technology Association of America.
The first PDGM national summit is scheduled for Jan. 23 in Orlando, with the program set to wrap March 26 in Dallas. For all points in between and more information, visit pdgm2019.nahc.org.