Home Health Pay-for-Reporting

June 22 2017 |Admin Admin
Home Health Pay-for-Reporting

Starting with the July 1, 2016 to June 30, 2017 the home health annual performance update (APU) period, the Quality Assessment Only (QAO) performance requirement has increased to 80%. The Home Health Conditions of Participation and the Social Security Act require certified agencies to submit OASIS data and CAHPS data at certain time points. Agencies that meet these reporting requirements are eligible to receive the full home health market basket annual payment update (APU) for the following year. Agencies that don't meet the reporting requirement are subject to a 2% payment reduction to the home health market basket APU. These requirements are known as the Home Health Pay-For-Reporting, or P4R, requirements.

Agencies can monitor their performance by accessing the QAO Interim Performance Reports found in their CASPER folders in QIES. In addition to the Interim Performance Reports, agencies receive an Annual QAO Performance Report. The Annual Report provides information on the agency’s annual compliance rate that will be used to calculate their APU. The QAO Interim and Annual Performance Reports will remain in the CASPER folders for 120 days. The following table provides an overview of the dates that the QAO Reports will be available in the CASPER folders and the corresponding OASIS completion and OASIS submission dates for each reporting period.


More information on the QAO metric and reports and on the P4R requirements can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html