CMS Pub. 100-02, ch. 7, § 10.7

A. Partial Payment Adjustment Criteria

An HHA receives a national, standardized 30-day payment of a predetermined rate for

home health services unless CMS determines an intervening event warrants a new 30-day period for purposes of payment.

The partial payment adjustment is a proportion of the period payment and is based on

the span of days including the start-of-care date (for example, the date of the first

billable service) through and including the last billable service date under the original

plan of care before the intervening event, defined as a—

● Beneficiary elected transfer, or

● Discharge and return to home health that would warrant, for purposes of payment, a

new OASIS assessment, certification of eligibility, and a new plan of care.

When a new 30-day period begins due to an intervening event, the original 30-day

period will be proportionally adjusted to reflect the length of time the beneficiary

remained under the agency’s care prior to the intervening event. The proportional

payment is the partial payment adjustment.

B. Methodology Used to Calculate Partial Payment Adjustment

The partial payment adjustment for the original 30-day period is calculated to reflect the

length of time the beneficiary remained under the care of the original HHA based on the

first billable visit date through and including the last billable visit date. The partial

payment adjustment will be calculated by using the span of days (first billable service

date through and including the last billable service date) under the original plan of care as

a proportion of the 30-day period. The proportion will then be multiplied by the original

case-mix and wage index to produce the 30-day payment.

C. Common Ownership Exception to Partial Payment Adjustment

The partial payment adjustment does not apply in situations of transfers among HHAs of

common ownership. Those situations would be considered services provided under

arrangement on behalf of the originating HHA by the receiving HHA with the ownership

interest until the end of the 30-day period. The common ownership exception to the

transfer partial payment adjustment does not apply if the beneficiary moved out of their

Metropolitan Statistical Area (MSA) or non-MSA during the 30-day period before the

transfer to the receiving HHA.

D. Beneficiary Elected Transfer Verification

In order for a receiving HHA to accept a beneficiary elected transfer, the receiving HHA

must document that the beneficiary has been informed that the initial HHA will no longer

receive Medicare payment on behalf of the patient and will no longer provide Medicare

covered services to the patient after the date of the patient's elected transfer in accordance

with current patient rights requirements at 42 CFR 484.50(d). The receiving HHA must

also document in the record that it accessed the Medicare contractor’s inquiry system to

determine whether or not the patient was under an established home health plan of care

and it must contact the initial HHA on the effective date of transfer. In the rare

circumstance of a dispute between HHAs, the Medicare contractor is responsible for

working with both HHAs to resolve the dispute. If the receiving HHA can provide

documentation of its notice of patient rights on Medicare payment liability provided to

the patient upon transfer and its contact of the initial HHA of the transfer date, then the

initial HHA will be ineligible for payment for the period of overlap in addition to the

appropriate partial payment adjustment. If the receiving HHA cannot provide the

appropriate documentation, the receiving HHA's RAP and/or final claim will be

cancelled, and full period payment will be provided to the initial HHA. For the receiving

HHA to properly document that it contacted the initial HHA on the effective date of

transfer it must maintain similar information as the initial HHA, including the same basic

beneficiary information, personnel contacted, dates and times. The initial HHA must also

properly document that it was contacted and it accepted the transfer. Where it disputes a

transfer, the initial HHA must call its Medicare contractor to resolve the dispute. The

Medicare contractor is responsible for working with both HHAs to resolve the dispute.