Certified Home Health Agency (CHHA) Rates
CHHA - Episodic Payment System (EPS)
Effective May 1, 2012, a new Episodic Payment System (EPS) reimbursement methodology to reimburse CHHA providers for services provided to Medicaid patients receiving home care services takes effect. The EPS is based on a price for 60-day episodes of care which will be adjusted by patient acuity and regional wage differences. The EPS was recommended by the Medicaid Redesign Team (MRT Proposal #5) and authorized in the 2011-12 Enacted Budget. The EPS is designed to address the issue of rapid growth in Medicaid costs per patient by better aligning payments with needed services and is part of a broad effort to promote the development of care management arrangements for Medicaid recipients.
For additional detailed information regarding the calculation of various components of the Episodic Payment System (EPS) of the CHHA pricing, please read below. Questions related to the new payment system can be directed to the Bureau of Long Term Care Reimbursement electronic mailbox: bltcr-ch@health.state.ny.us
Overview of EPS for CHHAs (PPT, 5.47MB). Also available in Portable Document Format* (PDF, 1.38MB, 54pg.)
- *Please note this pdf is not fully accessible
- EPS - Billing Guidelines - April 9, 2013
- EPS - Billing Update Regarding Medical Orders - Oct. 10, 2012
- EPS - Billing Update Regarding Service Lines - Sept. 25, 2012
- EPS - Billing Update Regarding Assessment Dates - August 29, 2012
- EPS - Additional Billing Guidance - July 1, 2012
- EPS - Additional Q & A - April 10, 2012
- EPS - Base Price, Resource Groups, Case Mix Indices, Outlier Thresholds, Rate Codes
- EPS - Regional Wage Index Factors
- EPS - Weighted Average Rates for LUPAs and Outliers
- EPS - New York State Medicaid Grouper
- EPS - Payment Calculation Examples
- EPS - Updated Q & A
- EPS - Spend Down Guidelines
- EPS - Spend Down Q & A
