US · guidance
CMS Pub. 100-04, ch. 10, § 10.1.5.2
Effect of Election of Medicare Advantage (MA) Organization
and Eligibility Changes on HH PPS
(Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21)
If a Medicare beneficiary is covered under an MA organization during a period of home
care, and subsequently decides to change to Medicare fee-for-service coverage, a new
OASIS assessment must be completed, as is required any time the Medicare payment
source changes. With that assessment, an NOA may be sent to Medicare to open an HH
PPS period.
If a beneficiary under fee-for-service receiving home care elects an MA organization
during an HH PPS period of care, the period will end and be proportionally paid
according to its shortened length (a partial period payment adjustment). The MA
organization becomes the primary payer upon the MA organization enrollment date.
.
History
(Rev. 10758; Issued: 05-11-21; Effective: 01-01-22; Implementation: 08-11-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a05e5d5d9e5a9b228b395dd3350f2bf47a9eded9932994c75892980e29f446fe
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