Code of Federal Regulations Title 42. Public Health § 42.484.215 Initial establishment of the calculation of the national, standardized prospective payment rates

(a) Determining an HHA's costs. In calculating the initial unadjusted national 60–day episode payment applicable for a service furnished by an HHA using data on the most recent available audited cost reports, CMS determines each HHA's costs by summing its allowable costs for the period. CMS determines the national mean cost per visit.

(b) Determining HHA utilization. In calculating the initial unadjusted national 60–day episode payment, CMS determines the national mean utilization for each of the six disciplines using home health claims data.

(c) Use of the market basket index. CMS uses the HHA market basket index to adjust the HHA cost data to reflect cost increases occurring between October 1, 1996 through September 30, 2001.

(d) Calculation of the unadjusted national average prospective payment amount for the 60–day episode. For episodes beginning on or before December 31, 2019, CMS calculates the unadjusted national 60–day episode payment in the following manner:

(e) Standardization of the data for variation in area wage levels and case-mix. CMS standardizes—

(f) For periods beginning on or after January 1, 2020, a national, standardized prospective 30–day payment rate applies. The national, standardized prospective 30–day payment rate is an amount determined by the Secretary, as subsequently adjusted in accordance with § 484.225.