Page 115 - CHHA Binder 2.3.20

4/11/2019

What is Case Rate?

 A value-based pricing method in which a flat monetary amount covers a
defined group of procedures and services, i.e. a single payment for all the
services provided during a “case”
• After the first visit, the agency receives a single payment for additional
services provided

• The first visit is usually paid as fee-for-service
 This rate does not vary based on # of services provided and is
not based on the patient’s condition as episodic payment is

• Most case rates have a visit limit (e.g., 15 visits, 60 visits or 30
days). Once this limit is reached, additional visits are usually paid at a
reduced fee-for-service rate
• Strong financial incentive to control # of services provided
• This payment methodology is increasing in popularity with Managed
Care plans.
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What is Case Rate?

• Value based agreements, similar to Medicare episodes, in which Managed
Care plans pay VNSNY a lump sum to cover care for an entire 60 day
episode
• These plans also include bonuses and penalties for performance and quality
outcomes, therefore:

It is vital that we
provide care which
patients need to meet
their goals…

…while monitoring the
appropriate utilization of
each episode

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