New York State Medicaid Grouper for Certified Home Health Agencies

Revised Effective Oct. 1, 2015

Grouper is based on four factors:

1. ASSESSMENT REASON - Start of Care (0) or Recertification (1)
2. CLINICAL MEASURES - Three Groups (A, B, C)
3. FUNCTIONAL MEASURES - Three Groups (E, F, G)
4. AGE GROUPS -

   (1) 18-59
   (2) 60-69
   (3) 70-74 (Groups 2 & 3 combined into one Resource Group effective 10/1/15)
   (4) 75-79
   (5) 80-84 (Groups 4 & 5 combined into one Resource Group effective 101/1/15)
   (6) 85 +

Assessment Reason:

Start of Care: M0100 = 1 or 3
Recertification: M0100 = 4 or 5

Clinical Factors:

1. Diabetes diagnoses
2. Dementia diagnoses
3. HIV diagnoses
4. Bowel incontinence
5. Urinary incontinence

Clinical Groups:

A = 0-1 points
B = 2-9 points
C = 10+ points

Functional Factors:

1. ADL Dressing upper body
2. ADL Dressing lower body
3. Toileting
4. Transferring

Functional Groups:

E = 0-9 points
F = 10-26 points
G = 27+ points