§ 484.210 - Data used for the calculation of the national prospective 60-day episode payment.

§ 484.210 Data used for the calculation of the national prospective 60-day episode payment.

Cross Reference

Link to an amendment published at 83 FR 56629, Nov. 13, 2018.

To calculate the national prospective 60-day episode payment, CMS uses the following:

(a) Medicare cost data on the most recent audited cost report data available.

(b) Utilization data based on Medicare claims.

(c) An appropriate wage index to adjust for area wage differences.

(d) The most recent projections of increases in costs from the HHA market basket index.

(e) OASIS assessment data and other data that account for the relative resource utilization for different HHA Medicare patient case-mix. An HHA must submit to CMS the OASIS data described at § 484.55(b)(1) and (d)(1) in order for CMS to administer the payment rate methodologies described in §§ 484.215, 484.230 and 484.235.

[65 FR 41212, July 3, 2000, as amended at 74 FR 58134, Nov. 10, 2009]