Home Health Patient-Driven Groupings Model (PDGM)

Effective for claims with a "From" date on or after January 1, 2020, Change Request (CR) 11081 implements the policies of the home health Patient-Driven Groupings Model (PDGM) as described in the Calendar Year (CY) 2019 home health (HH) final rule (CMS-1689-FC). The PDGM changes the unit of payment from 60-day episodes of care to 30-day periods of care, eliminates the therapy thresholds used in determining home health payment and includes other operation changes.

Resources:

  • Home Health Patient-Driven Groupings Model Operational Issues Call Presentation, Presentation Clarification, Audio Recording and Transcript from August 21, 2019
  • Centers for Medicare & Medicaid Services Patient-Driven Groupings Model (PDF, 449 KB)
  • SE19027: Overview of the Patient-Driven Groupings Model (PDF, 300 KB)
  • SE19028: Payments and Payment Adjustments under the Patient-Driven Groupings Model (PDF, 498 KB)
  • MM11081: Home Health Patient-Driven Groupings Model (PDGM) – Split Implementation (PDF, 112 KB)
  • MM11272: Home Health Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions (PDF, 236 KB)
  • MM11395: Home Health (HH) Patient-Driven Groupings Model (PDGM) - Revised and Additional Manual Instructions (PDF, 72 KB)
  • MM11527: Home Health (HH) Patient-Driven Groupings Model (PDGM) - Revised and Additional Manual Instructions (PDF, 78 KB)
  • Home Health Agency (HHA) Center
  • Overview of the PDGM Model Medicare Learning Network Call Presentation, Audio Recording, and Transcript– February 12, 2019

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