What is PDGM?

The Patient-Driven Groupings Model (PDGM) is a new payment model for the home health industry that relies more heavily on clinical characteristics and patient information to determine care. It eliminates the use of therapy service thresholds and changes the basic unit of home health payment from a 60-day episode to 30 days. The National Association of Home Care & Hospice calls it “the biggest change to the payment system in the 21st century.”

PDGM is set to take effect Jan. 1, 2020. To help home health business stay informed, we’ve set up this page that will keep up with the latest updates. Check back frequently for more news, guidance and learning opportunities.


WASHINGTON—The Centers for Medicare & Medicaid’s (CMS) proposed rate reductions for home health could be devastating for agencies if they are codified, said Bill Dombi, president of the National Association for Home Care & Hospice (NAHC). Even worse, CMS has left a door open to demand some $3 billion in clawbacks for prior years of what it interprets as over-payments.  

WASHINGTON, D.C. (November 1, 2022)—The Centers for Medicare & Medicaid Services (CMS) released its final rule for Medicare home health payments on October 31, settling on a rate reduction of 3.925% for 2023 with additional cuts to come in 2024. That's less than the 7.69% cut initially proposed by the agency for 2023, but still a blow to providers, according to industry advocates.

WASHINGTON, D.C. (September 24, 2021)—The Medicare Payment Advisory Commission (MedPAC) met to discuss the development of a mandated report assessing the impact of the shift to the Patient Driven Groupings Model (PDGM) payment model for Medicare home health, and in particular the 30-day episode and the removal of therapy utilization in payment determinations.

WASHINGTON, D.C. (November 6, 2020)—The Centers for Medicare & Medicaid Services (CMS) has issued another revision to change request 11855—Penalty for Delayed Request for Anticipated Payment (RAP) Submission—Implementation. The Change Request (CR) revision added remittance advice message information related to the No Pay RAP penalty.

Home health agencies (HHAs) should note that Medicare Administrative Contractors (MACs) will: 

WASHINGTON, D.C. (August 28, 2020)—The Partnership for Quality Home Healthcare—a coalition of home health leaders dedicated to developing innovative reforms to improve the program integrity, quality, and efficiency of home healthcare for our nation's seniors—submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) in response to the CY 2021 Home Health Prospective Payment System (HH PPS) Proposed Rule.