Home health providers continue to await final word on payment adjustments for 2026, along with key regulatory changes expected in the 2026 Home Health Prospective Payment System final rule.
 
Delayed by the federal shutdown, the HHPPS rule is typically released around November 1 to allow 60 days for providers to prepare for changes effective January 1. If the rule is delayed into next week, agencies will have less than a month.
 
In June, CMS proposed a 6.4% aggregate payment cut for home health providers. That includes:  
  • A 2.4% payment increase to account for rising agency costs.
  • A 4.1% permanent payment decrease as part of the controversial behavior adjustment to account for perceived industry changes since 2020 under the Patient-Driven Groupings Model (PDGM).
  • A 5% one-time “temporary” payment decrease to begin to address what CMS claims is $5.3 billion in overpayments during the first four years under PDGM.
Regulatory changes expected in the final rule include:
  • A shorter, easier-to-answer HHCAHPS survey, effective April 1, with associated changes to the patient survey star rating.
  • Updated quality measures for HHVBP, including additional OASIS items, Medicare spending per beneficiary and the removal of some HHCAHPS measures due to the survey changes.
  • More options for face-to-face encounters when a community physician refers the patient for home health care.
  • Removal of the COVID-19 vaccine question in the OASIS. Agencies will no longer be measured on the item, effective Jan. 1, though it will require some sort of valid response until it is removed with OASIS-E2 in April.
Home Health Line will deliver a breaking news update to your inbox when the rule is released, along with special coverage in an upcoming issue.