New York State Medicaid Grouper for Certified Home Health Agencies

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
    (4) 75-79
    (5) 80-84
    (6) 85 +

Assessment Reason:

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

Clinical Factors:

  1. Diabetes diagnoses
  2. Orthopedic diagnoses
  3. Dementia diagnoses
  4. HIV diagnoses
  5. Bowel incontinence
  6. Urinary incontinence
  7. Shortness of breath

Clinical Groups:

A = 0-4 points
B = 5-14 points
C = 15+ points

Functional Factors:

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

Functional Groups:

E = 0-18 points
F = 19-51 points
G = 52+ points