---
kind: "section"
citation: "42 C.F.R. § 484.220"
title: "42"
number: "484.220"
heading: "Calculation of the case-mix and wage area adjusted prospective payment rates."
url: "https://uscodex.org/cfr/42/484.220"
---

# §484.220. Calculation of the case-mix and wage area adjusted prospective payment rates.


CMS adjusts the national, standardized prospective payment rates as referenced in [§ 484.215](/cfr/42/484.215.md) to account for the following:

- (a) HHA case-mix using a case-mix index to explain the relative resource utilization of different patients. To address changes to the case-mix that are a result of changes in the coding or classification of different units of service that do not reflect real changes in case-mix, the national, standardized prospective payment rate will be adjusted downward as follows:
  - (1) For CY 2008, the adjustment is 2.75 percent.
  - (2) For CY 2009 and CY 2010, the adjustment is 2.75 percent in each year.
  - (3) For CY 2011, the adjustment is 3.79 percent.
  - (4) For CY 2012, the adjustment is 3.79 percent.
  - (5) For CY 2013, the adjustment is 1.32 percent.
  - (6) For CY 2016, CY 2017, and CY 2018, the adjustment is 0.97 percent in each year.
- (b) Geographic differences in wage levels using an appropriate wage index based on the site of service of the beneficiary.
- (c) Beginning on January 1, 2023, CMS applies a cap on decreases to the home health wage index such that the wage index applied to a geographic area is not less than 95 percent of the wage index applied to that geographic area in the prior calendar year. The 5-percent cap on negative wage index changes is implemented in a budget neutral manner through the use of wage index budget neutrality factors.

## Notes

### Amendments

[72 FR 49879, Aug. 29, 2007, as amended at 80 FR 68717, Nov. 5, 2015; 83 FR 56629, Nov. 13, 2018; 87 FR 66886, Nov. 4, 2022]

### Source

Source: 65 FR 41212, July 3, 2000, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 54 FR 33367, Aug. 14, 1989, unless otherwise noted.

### Amendments

[72 FR 49879, Aug. 29, 2007, as amended at 80 FR 68717, Nov. 5, 2015; 83 FR 56629, Nov. 13, 2018; 87 FR 66886, Nov. 4, 2022]