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Home Health Payment Reform – The Home Health Groupings Model (HHGM)

Michael Plotzke
Centers for Medicare & Medicaid Services


August 23, 2016

Examined costs associated with beneficiaries who were: low-income, lived in underserved areas, had high severity of illness The report found current payment system produced lower margins for those:

  • Needing parenteral nutrition
  • With traumatic wounds or ulcers
  • Who required substantial assistance in bathing
  • Admitted to home health following an acute or post-acute stay
  • Who have a high Hierarchical Condition Category score
  • Who had certain poorly controlled clinical conditions
  • Who were dual eligible