Home Health Prospective Payment System (HH PPS) Limited Data Set (LDS)

The “Home Health Claims – OASIS” LDS file contains information on the utilization of the Medicare Home Health benefit. For CY 2023, the HH PPS LDS file will contain two separate datasets. One of the datasets is constructed so that each observation represents a particular home health 30-day period in a given year.  The other dataset is constructed so each observation represents a simulated 60-day episode, using data from the 30-day periods contained in the other dataset. These simulated 60-day episodes represent hypothetical claims that would have been in effect prior to implementation of the Patient-Driven Groupings Model (PDGM). It is important to note, there were no actual 60-day claims submitted in CY 2023. Further information about the creation of the simulated 60-day episodes can be found in the CYs 2023, 2024, and 2025 HH PPS Proposed Rules.

Observations are stripped of most data elements that will permit identification of beneficiaries. Section 51001 of the Bipartisan Budget Act of 2018 (BBA of 2018) included several requirements for home health payment reform. These requirements include the elimination of the use of therapy thresholds for case-mix adjustment and a change from a 60-day unit of payment to a 30-day unit of payment. In the CY 2019 HH PPS final rule with comment period (83 FR 56406), CMS finalized the case-mix methodology refinements through the PDGM for home health periods of care beginning on or after January 1, 2020. Information in both datasets include:

• Start and end dates of the observations
• Wage index value associated with each observation
• HIPPS codes that reflect the case-mix components
  • “hipps” is the predicted 30-day period HIPPS code for CY 2025 based on recalibration
  • “hipps_r” is the actual 30-day period HIPPS code for CY 2023
• Case-mix weights based on the respective case-mix methodology (PDGM or 153-group)
• Indicators for whether the observation receives a payment adjustment (LUPA, partial payment adjustments, outlier)
• Estimated payments for the observation that reflect the payment parameters in the rule that is released along with the HH PPS LDS file as well as payments calculated for the permanent adjustment methodology
• Information on number and length of visits by discipline for each observation

On the 30-day period dataset we include information regarding the resource use of each observation, indicators for which 30-day periods were used to construct 60-day episodes, and select information from the Outcome and Assessment Information Set (OASIS) that is used in the payment system

On the 60-day episode dataset we include OASIS items relevant for grouping 60-day episodes

NOTE:  Any given “Home Health Claims – OASIS” file represents a static snapshot of a specific period at the time the data was sourced from the Chronic Conditions Data Warehouse.  As such, any given record DOES NOT NECESSARILY represent the final coding and/or payment information for that period because if subsequent adjustments to the claims occur after the “Home Health Claims – OASIS” file is completed, they will not be reflected on the file.

The “Home Health Claims – OASIS” LDS file will be updated twice a year. The first update will correspond to annual notices of proposed rulemaking, released in the early summer, and the second update will correspond to the final rule released in the fall.

• The variable layout that accompanies this file can be found under the Downloads section below.
• Visit the Home Health Prospective Payment System Regulations and Notices webpage for current regulations that presents HH PPS rate updates, case-mix adjustment methodology refinements and a file containing summary level descriptive statistics from the LDS file.

Media: DVD  
Cost: $1,500  
Data Format: Comma separated variable block with SAS® read-in program
Available: CY 2023

To browse the record layout, see the Downloads section below.