CMS Pub. 100-04, ch. 10, § 10.1.14

Payment Effects

(Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21)

Under HH PPS, HHAs may discharge beneficiaries before the period of care has closed if

all treatment goals of the plan of care have been met. Cases may occur in which an HHA

has discharged a beneficiary during a period of care, but the beneficiary is readmitted to

the same agency in the same 30 days. Since no portion of the period can be paid twice,

the first payment must be pro-rated to reflect the shortened period (see §10.1.15). A new

admission period can be opened by the HHA. Medicare systems will allow this in cases

where the CMS certification number (CCN) on the new NOA matches the CCN on the

prior period. The next period of care will begin the date the first service is supplied under

readmission (setting a new 30-day “clock”).

Note that beneficiaries do not have to be discharged within the period because of

admissions to other types of health care providers (i.e., hospitals, skilled nursing

facilities), but HHAs may choose to discharge in such cases. If an agency chooses not to

discharge and the patient returns to the agency in the same 30-day period, the same

period of care continues. However, if an agency chooses to discharge, based on an

expectation that the beneficiary will not return, the agency should recognize that if the

beneficiary does return to them in the same period, the discharge is not recognized for

Medicare payment purposes. All the HH services provided in the complete period of

care, both before and after the inpatient stay, should be billed on one claim. When

discharging, full payment would still be made unless the beneficiary received more home

care later in the same period.

Discharge is not required if the beneficiary has an inpatient stay that spans the end of the

first 30-day period of care in a 60-day certification period. The HHA should submit the

claim for the period following the discharge as if the 30-day periods were contiguous –

submit a From date of day 31, even though it falls during the inpatient stay and the first

visit date that occurs after the hospital discharge. Medicare systems will allow the HH

claim to overlap the inpatient claim for dates in which there are no HH visits.