Home Health Case Mix Grouper Software Package

Etiology and Manifestation Flags in V3312

Historically the Home Health Prospective Payment System (HH PPS) Grouper has output a data validation flag (A-H) upon encountering a manifestation code assigned to a Diagnosis Group (DG) that may potentially score but lacks an approved etiology code.  This flag has been provided to alert Home Health Agencies (HHAs) to situations in which they may have failed to conform to HH PPS reporting requirements for diagnosis codes.  It should be noted that the validation flag was neither intended as a guide for HHAs to maximize payment nor as an alternative to following coding guidelines.
 
Numerous recent changes have been made to the HH PPS Grouper to encourage complete and consistent reporting of diagnosis codes by HHAs. With the release of V3312 the requirement for an etiology code to immediately precede a manifestation code to meet scoring validation requirements has been removed. This logic change has resulted in a change to the operation of the manifestation / etiology data validation flag. This manifestation / etiology validation flag in the most recent release is restricted to identifying the validation of codes submitted in the Primary Diagnosis and Payment Diagnosis Fields. After receiving industry comment, we will look to restore the extended use of the validation flag to secondary diagnoses in future releases.
 
The change in validity flag operation does not affect HIPPS code assignment or payments to HHAs, and has no impact upon assessments where the assessment date precedes January 1, 2012, the point at which the etiology/manifestation processing revision took effect.

Home Health Case Mix Grouper Software Package

CMS is updating the HH PPS Grouper (V3312) to reflect a correction that is effective for OASIS records with a date of 10/1/2011 and later. We have added two dementia codes, 294.20 and 294.21 to the HH PPS case-mix system. Specifically, it includes these codes in diagnosis group 17 – Psych 2. In addition, the grouper includes changes required to effectuate the policy changes finalized in the CY 2012 Home Health PPS final rule. Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes. Also as explained in the final rule, the scoring table has been revised to take into account these changes. The materials provided include an updated version (V3312) of the grouper logic (JAVA source code) and associated tables, an updated JAVA.dll software module and updated test cases to be used by those developing their own software to implement the grouper logic. (See the Downloads section below.)

CMS is Soliciting Beta Site Testers

Thank you for your interest in participating in the beta testing of the Home Health Grouper for the CMS Home Health Prospective Payment System.

The Beta Process

Approximately fifteen (15) business days prior to each general release, you will be provided with a beta test package. This will be distributed to a designated recipient of your choice via a downloadable web “drop box” hosted by 3M. The designated recipient will be required to supply a contact e-mail address.

During the annual release cycle intermediate version changes may be made available to beta testers for review. There is no requirement to test these versions in order to retain beta site status however the requirement for confidentiality surrounding intermediate versions is essential.

Expectations

Upon receipt of the beta package, you will be expected to:

• Test the application by running several hundred assessments through the software; there should be adequate representation of all documented changes implemented for the update
• Analyze the output from the HH Grouper in the return buffers for a reduced sample of assessments, specifically:

          - From the reduced sample select 5-10 records from each of the 5 Grouping Steps

          - Manually confirm that the grouper output (HIPPS codes and validation Flags) match the manual calculations

• Complete testing and report on your findings within 10-days of having the beta release made available.

Communication

During beta testing communication needs to be immediate and direct.

• The designated contact will be expected to communicate with 3M if any problems are identified in the installation or application testing, or if any questions or comments arise during the beta testing.
• 3M Contact names, e-mail addresses and phone numbers will be provided to beta test designees with each distribution of the web drop box.
• At the conclusion of testing, a summary of the testing results is requested.

Confidentiality

Software and information will be released to you for HH Grouper beta testing before being released by CMS to the general public.  With the exception of your designated contact at 3M, this material may not be discussed with, or distributed to anyone outside of your organization. To prevent unauthorized release, access to this information within your organization should be limited to individuals who are directly involved in the beta testing.

To enroll as a beta site, vendors will be required to e-mail us at:  grouperemail@mmm.com

We will respond to the e-mail requesting additional contact information.