Welcome Logout

Home Health Agency Claims Held in Anticipation of TRICARE® Demonstration

Friday, January 17, 2020

The Centers for Medicare & Medicaid Services (CMS) Home Health Value-Based Purchasing (HHVBP) Model offers financial incentives to home health agencies (HHAs) who perform efficient, higher quality care. This model was rolled out by CMS in 2016 to nine states, four of which are in the TRICARE West Region: Arizona, Iowa, Nebraska, and Washington. The Defense Health Agency (DHA) is in the process of updating its TRICARE manuals to include an HHVBP Demonstration and a Patient-Driven Groupings Model (PDGM) that is based on CMS’ HHVBP and PDGM pricing. We anticipate TRICARE’s HHVBP Demonstration and PDGM reimbursement to be effective retroactive to Jan. 1, 2020.

As we await the TRICARE manual revisions to publish, we will be holding home health agency claims for new episodes of care that start on or after Jan. 1, 2020, for all West Region states. (The episode of care start date is the ‘From Date’ on the claim form.) Due to the complexity of HHA pricing and the expected new billing requirements, we are taking this step to help providers avoid having to resubmit claims. 

We will move forward with implementing TRICARE’s HHVBP Demonstration, and PDGM reimbursement, to include the release of held claims, upon direction from DHA.