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Home Health Value-Based Purchasing Demonstration

Thursday, October 8, 2020

In 2016, the Centers for Medicare & Medicaid Services (CMS) rolled out a Home Health Value-Based Purchasing (HHVBP) model for home health agencies (HHAs) in nine U.S. states, four of which are in the TRICARE West Region. The HHVBP offers financial incentives to HHAs who perform efficient, higher quality care. Retroactive to Jan. 1, 2020, TRICARE has adopted Medicare’s HHVPB under its HHVPB Demonstration. Please refer to TRICARE Operations Manual, Chapter 29, Section 6.

Participation in the demonstration is mandatory for all TRICARE-authorized HHAs (network and non-network) that are Medicare-certified and provide services in Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington effective for calendar year 2020.

Under the HHVBP model, CMS determines a payment adjustment based upon the HHA Total Performance Score (TPS), a measurement of quality performance. This payment adjustment applies to all TRICARE HHA PPS claims, including the Patient-Driven Groupings Model (PDGM). For information on quality measures and methodologies used for calculating the payment adjustment factor, go to https://innovation.cms.gov/initiatives/home-health-value-based-purchasing-model

A payment adjustment report or PAR is provided once a year to each of the HHAs by CMS. HHAs that provide services in the above-listed states must submit TPS and PAR reports to the appropriate TRICARE contractor by Dec. 31 each year in order to avoid financial penalty. Please submit your reports to us using the “Upload a Document” on our website (log in required) or via postal mail or fax:

TRICARE West PDM Correspondence
PO Box 202106
Florence, SC 29502-2106
Fax: 1-844-730-1373

For more information on HHVBP, visit our Home Health billing tips.  

Release of home health agency claims
In anticipation of the PDGM pricing, HNFS held all home health agency claims in the West Region so providers wouldn’t have to re-submit claims while we were completing necessary system updates. We are happy to report that as of September 2020, held home health agency claims have been released.