HHA-PPS 3 Percent Rural Added-On
5/1/2012
A temporary 3 percent rural add-on for the Home Health Prospective Payment System (HHA-PPS) was added to the TRICARE Reimbursement Manual, per Section 3131 of the Patient Protection and Affordable Care Act (PPACA), on March 13, 2011. PPACA mandated that the Centers for Medicare and Medicaid Services (CMS) apply the rural add-on for HHA-PPS services; TRICARE followed CMS’ lead on the issue.
The 3 percent increase is for home health services furnished to beneficiaries residing in a rural area with episodes and visits ending on or after April 1, 2010 and before January 1, 2016. It became effective with claims processed starting on July 21, 2010 by Wisconsin Physicians Service Insurance Corporation (WPS).
The 3 percent rural add-on is applied to the national standardized 60-day episode rate, the national per-visit rates, the Low Utilization Payment Adjustment (LUPA) add-on payment amount, and the NRS conversion factor when home health services are provided in rural (non-Core Based Statistical Area [CBSA]) areas. The applicable case-mix and wage index adjustments are subsequently applied. Episodes that qualify for the 3 percent rural add-on will be identified by a CBSA code that begins with ‘999.’
For more information, please refer to TRICARE Reimbursement Manual, Chapter 12, Addendum L (CY 2010), at TRICARE.mil.