Number, Duration, and Claims Submission of HH PPS Periods

10.1.5 - Number, Duration, and Claims Submission of HH PPS Periods of Care (Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21) The beneficiary can be covered for an unlimited number of nonoverlapping periods of care. For periods of care beginning on or after January 1, 2020, the duration of a period is 30 days. Periods of care may be shorter than 30 days. For example, a period may end earlier than the 30th day in the case of a transfer to another HHA, or a discharge and readmission to the same HHA, and payment is pro-rated for these shortened periods, in which more home care is delivered in the same period. Claims for periods may be submitted prior to the 30th day if the beneficiary has been discharged and treatment goals have been met, though payment will not be pro-rated unless more home health care is subsequently billed in the same period. Other claims for overlapping periods may also be submitted prior to the end of that period if the beneficiary has been discharged, dies or is transferred to another HHA. In transfer cases payment for the period of care will be prorated. The initial period begins with the first service delivered under that plan of care. A second subsequent period of continuous care would start on the first day after the initial period was completed. More than one period for a single beneficiary may be opened by the same or different HHAs for different dates of service. This will occur particularly if a transfer to another HHA, or discharge and readmission to the same HHA, situation exists. Refer to §10.1.5.1 below for more information on multiple agencies furnishing home health services. Allowing multiple periods is intended to assure continuity of care and payment.