Home Health PPS Grouper Software (HHGS)

Home Health PPS Grouper Software (HHGS)

 In the CY 2025 Home Health Prospective Payment System (HH PPS) Proposed Rule (89 FR 55361) we reminded readers that the ICD–10–CM diagnosis codes are granular and specific and provide HHAs a better opportunity to report codes that best reflect the patient’s conditions that support the need for home health services. However, as stated in the CY 2019 HH PPS final rule with comment period (83 FR 56473), because the ICD–10–CM is comprehensive, it also contains many codes that may not support the need for home health services. Therefore, not all the ICD–10–CM diagnosis codes are appropriate as principal diagnosis codes for grouping home health periods into clinical groups or to be placed into a comorbidity subgroup when listed as a secondary diagnosis.

ICD-10-CM diagnosis code Z51.A Encounter for sepsis aftercare, does not clearly support a rationale for home health services under application of home health policy. As we stated in the CY 2020 HH PPS final rule (84 FR 60510) we believe that by the time a home health referral is made, a more definitive principal diagnosis is warranted to justify the need for skilled services and appropriate treatment in the home care setting. We maintain that diagnosis code Z51.A will not be assigned a clinical group under the HH PPS. Beginning FY 2025, if diagnosis code Z51.A is reported as a principal diagnosis the HH Grouper software will send a return code of “05” which indicates the principal diagnosis is not assigned to a clinical group.

At this time, Z51.A is not listed in the “Z Codes That May Only be Principal/First-Listed Diagnosis” list and would be acceptable as a secondary diagnosis. Additionally, per the 2025 ICD-10-CM Tabular List of Diseases and Injuries codes under category Z51 have a “code also” note. A “code also” note instructs that two codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the conditions and the reason for the encounter. For example, a patient is discharged to home health following an acute care stay for sepsis. The reason the patient is needing HH care is due to lymphedema as a result of the sepsis and requires rehabilitation and nursing services in the HH setting. The principal diagnosis would be lymphedema (e.g., diagnosis code I89.0) for the purposes of the PDGM clinical group assignment. The Z51.A would be sequenced as a secondary code to identify the patient is receiving sepsis aftercare.

Home Health PPS Grouper Software (HHGS) Package (for claims starting 01-01-2025)

The January 2025 release of the HH PPS Grouper software (v06.0.25) is now available in the “Downloads” section of this webpage. A summary of the changes for what is included in the v06.0.25 HH PPS Grouper software update is listed below.

In November 2018, CMS finalized a case-mix classification model, the Patient-Driven Groupings Model (PDGM), effective beginning January 1, 2020. The PDGM, or Home Health PPS Grouper Software (HHGS), relies more heavily on clinical characteristics and other patient information to place home health periods of care into meaningful payment categories and eliminates the use of therapy service thresholds. In conjunction with the implementation of the PDGM, there will be a change in the unit of home health payment from a 60-day episode to a 30-day period.

The following reflects the changes included in the v06.0.25 software update:

  • There are no software logic or interface changes for v06.0.25.

The following tables impacting grouping logic and HIPPS code assignments are updated effective January 1, 2025. The following Grouper tables have been modified (see details in the Summary of Changes document):

  • Comorbidity_Groups: additions and deletions of comorbidity groups and modifications to
  • low comorbidity adjustment flag for subgroups
  • Comorbidity_Interactions: additions and deletions of comorbidity interactions
  • Diagnosis Code_Changes: change to one diagnosis code’s clinical group assignment
  • FI_Responses: updated point values for specific functional impairments
  • Clinical_Groups: updated threshold value ranges for Clinical Groups

Notice Regarding Upcoming Releases of the Home Health PPS Grouper

The current version of Home Health PPS Grouper uses Java software and is currently based on Java version 8.  Support for Java version 8 will end by November 2026.  Home health agencies and their software vendors who implement the HH Grouper in a mainframe environment will be impacted by this change. CMS is preparing now to convert the programs to Java version 17.   

As with the October 2024 update, the January 2025 and subsequent quarterly releases of the HH Grouper will include two Common Business-Oriented Language (COBOL) Java bridge modules instead of the one that is currently delivered.  We will continue to provide the existing bridge module that utilizes the 31-bit, Java 8 Java Virtual Machine (JVM) environment.   We will also provide a new bridge module that will utilize the 64-bit, Java 17 JVM.  The Java jar file for each will continue to be compiled using Java 8.  This will preserve backwards compatibility with all existing mainframe deployments (both batch and Customer Information Control System (CICS)).  The installation guides for the program will provide notice of the changes. This will allow users to test upgrades to their systems over the next year to prepare to move to Java 17. 

The release of the HH Grouper effective October 2025, will be compiled with Java 17 and only the Java 17, 64-bit COBOL calling module will be delivered.  Providers and their software vendors should begin planning this year to ensure they are prepared for this conversion next fall. 

Questions about the Java 17 conversion can be sent at any time to the resource mailbox HHGrouperQuestions@cms.hhs.gov.  

Support for the HH-PPS Grouper Software

Additional information can be found in the Frequently Asked Questions (PDF)

For related questions, please use the following contacts:

Note:
Please do not submit Protected Health Information through this email system. It is not necessary to send personally identifiable data to demonstrate your question or concern.

Home Health PPS Grouper Software Package (for claims through 12-31-2019)

Archived versions of the Home Health Prospective Payment System (HH PPS) Grouper are available for download. The HH PPS Grouper software will only work for OASIS submissions with an assessment completion date from through December 31, 2019. Effective January 1, 2020 the Home Health Patient Driven Grouping Model, or revised Home Health PPS Grouper Software (HHGS), will be used to process Home Health claims.

Downloads

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Page Last Modified:
11/04/2024 10:57 AM
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