Home Health Patient-Driven Groupings Model (PDGM)
The Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1689-FC)
that updates the Medicare Home Health Prospective Payment System (HH PPS) rates and wage index for calendar year (CY) 2019. Change Request 11081
implements the policies of the Patient-Driven Groupings Model (PDGM), effective with claim “From” dates on or after January 1, 2020. For more information, please refer to the following resources.
CGS Resources:
- CGS Overview: Home Health Patient-Driven Groupings Model (PDGM)
- Top Provider Questions – Home Health Patient-Driven Groupings Model (PDGM)
- Request for Anticipated Payment (RAP) Changes in Calendar Year 2021 Fact Sheet

- Submitting a Request for Anticipated Payment (RAP)
- Submitting a Final Claim
Self Service Options:
CMS Resources:
- CMS CY 2020 Home Health Final Rule with Comment Period

- CMS Home Health Patient-Driven Groupings Model Web page

- CMS CY 2020 Interactive Grouper Tool

- CMS CY 2020 PDGM Case Mix Weights and LUPA Thresholds

- August 21, 2019, Home Health Patient-Driven Groupings Model: Operational Issues presentation
- February 12, 2019, Overview of the Patient-Driven Groupings Model (PDGM)
presentation
- MM11577 – Manual Updates Related to Calendar Year (CY) 2020 Home Health Payment Policy Changes, Maintenance Therapy, and Remote Patient Monitoring

- MM11527 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions

- MM11395 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions

- MM11272 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Additional Manual Instructions

- MM11081 – Home Health Patient-Driven Groupings Model (PDGM) – Split Implementation

- SE20005 – The Role of Therapy under the Home Health Patient-Driven Groupings Model (PDGM)

- SE19027 – Overview of the Patient-Driven Groupings Model

- SE19028 – Payments and Payment Adjustments under the Patient-Driven Groupings Model

- Home Health Agency (HHA) Center

Updated: 09.24.2025

