What Do Home Health Agencies Need to Know About CMS’s Final 2026 Home Health Payment Rule?

On November 28, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the final rule for CY 2026 under the Home Health Prospective Payment System (HH PPS) (CMS-1828-F). This rule finalizes updated payment rates, recalibration of case-mix and payment groupings under the Patient-Driven Groupings Model (PDGM), quality-reporting changes, and expanded oversight and program integrity provisions.  

What Is the Big Picture for the 2026 Home Health Payment Final Rule?

Although the final rule includes a routine payment update, CMS projects that aggregate Medicare payments to home health agencies (HHAs) will decrease by about 1.3% in 2026 (roughly $220 million less than 2025) when all adjustments are applied.

This reflects a modest net reduction compared with earlier, more severe proposals — CMS notes the typical 30-day payment amount will drop by around $19 per 30-day period under the final adjustments (vs ~\$60 under the proposed rule).  

How Will Payment Rates and PDGM Change in 2026?

Under the final rule:

• CMS applies a +2.4% payment update to the national, standardized 30-day period payment rate. : 
• CMS finalizes a –1.023% permanent adjustment and a –3.0% temporary adjustment to the base payment rate. 
• PDGM case-mix weights, comorbidity subgroups, functional impairment levels, and low-utilization payment adjustment (LUPA) thresholds are recalibrated using updated 2024 claims data. : 
• National per-visit payment rates (for LUPAs and visits used in outlier calculations) are updated using the 2.4% payment update.  

What Are the Key Payment Adjustments in the 2026 Final Rule?

The combination of updates and adjustments leads to a net decrease in aggregate payments: a 2.4% increase is offset by permanent and temporary reductions, resulting in an estimated overall –1.3% decrease compared with 2025. The per-30-day payment reduction is smaller than initially proposed, thanks to updated behavior-change analyses. 

What PDGM-Related Changes Should Agencies Expect?

Key PDGM-related changes for 2026 include:

• Updated case-mix weights, comorbidity subgroups, functional impairment levels, and LUPA thresholds, all based on 2024 Medicare claims data. 
• National per-visit and per-30-day payment rates adjusted, with the per-visit rates used for LUPAs rising with the 2.4% update. 
• Continued use of the 30-day payment unit (as established under PDGM), but with recalibrated payment parameters that better reflect recent utilization and visit patterns. 

How Is the Home Health Quality Reporting Program (HH QRP) Changing in 2026?

The final rule makes several updates to quality reporting requirements under the Home Health Quality Reporting Program. 

Which Quality Measures Are Being Removed from HH QRP?

CMS is removing the COVID-19 Vaccine: Percent of Patients Who Are Up to Date measure. Additionally, four standardized patient assessment data elements will be removed (one Living Situation item, two Food items, and one Utilities item). :

What New and Updated Quality Reporting Requirements Will Apply in 2026?

Beginning in April 2026 (sample month), a revised HHCAHPS® survey will be implemented under HH QRP. CMS also finalizes updates to reconsideration processes and extraordinary-circumstance exception procedures.

How Is the Home Health Value-Based Purchasing (HHVBP) Model Changing?

The final rule updates the Home Health Value-Based Purchasing Model (HHVBP) measure set, including removals and additions of measures, and adjustments to measure weighting. 

Which HHVBP Measures Are Being Removed?

Under HHVBP, three HHCAHPS®-based measures are being removed. 

What New Measures Are Being Added to HHVBP?

New measures added to HHVBP include:

• Claims-based Medicare Spending per Beneficiary – Post-Acute Care (MSPB‑PAC). 
• Three new functional measures based on the Outcome and Assessment Information Set (OASIS), focused on: discussing home safety with patients, reviewing prescribed and over-the-counter medications, and discussing medication side effects. 

How Will HHVBP Measure Weighting Be Adjusted?

The final rule includes adjusted weighting across measure categories in HHVBP to reflect the updated measure set and to better align quality-based payment incentives with the new priorities.

What Does the OASIS Clarification Under the Conditions of Participation (CoPs) Mean for Agencies?

The rule clarifies that the OASIS all-payer submission requirement applies to all HHA patients receiving “skilled services,” regardless of payer. In other words, OASIS reporting is no longer limited to Medicare—it applies across payers where skilled home health care is provided.

How Is CMS Tightening Provider Enrollment Oversight and Timelines?

The final rule expands grounds for denial, revocation, and deactivation of provider enrollment. It shortens the required reporting timeframe for adverse legal actions to 30 days (previously 90 days), and expands CMS’s authority to apply retroactive effective dates when necessary.

What Do These 2026 CMS Changes Mean for Home Health Agencies?

Collectively, the 2026 changes signal tighter financial margins, increased operational scrutiny, enhanced quality-reporting and compliance demands, and greater importance on documentation accuracy, patient assessment, and regulatory adherence. Agencies that effectively manage documentation, quality reporting, and operational workflows will be better positioned to withstand payment reductions and leverage value-based incentives under HHVBP.

What Action Steps Should Home Health Agencies Take Now?

Agencies should proactively model financial impacts, review operational workflows, update quality reporting plans, strengthen compliance/enrollment monitoring, and prepare for new HHVBP measures. Agencies that begin adjusting now will be better prepared for the Jan 1, 2026 effective date.

1. Model the Financial Impact of the 2026 Final Rule

Calculate scenarios based on the –1.3% aggregate payment decrease. Adjust budgets, cash-flow projections, and staffing plans to account for reduced per-30-day payment rates and recalibrated PDGM case-mix payments (including LUPAs, per-visit rates, and outlier calculations). Review your payor mix and quality-data submission status (since quality reporting affects payment adjustments).

2. Review PDGM Operations

Ensure clinical and administrative staff understand the updated case-mix weights, LUPA thresholds, and functional impairment level adjustments. Analyze historical utilization patterns to anticipate how the changes might affect reimbursement under each PDGM subgroup. Adjust visit planning and documentation accordingly.

3. Prepare for New HHVBP Measures

Update intake, assessment, and documentation workflows to capture the new OASIS-based functional measures (home safety, medication review, medication side-effect discussion). Train staff to consistently discuss and document these topics. Review existing HHCAHPS® processes in anticipation of the revised survey launching April 2026.

4. Update Quality Reporting and HHCAHPS® Workflows

Revise quality reporting plans to account for removal of certain reporting items (e.g., COVID-19 vaccine measure, patient assessment items). Ensure the revised HHCAHPS® survey process is implemented and staff are trained on new reporting requirements. Confirm data-submission workflows and deadlines to avoid penalty or payment adjustment.

5. Tighten Compliance and Enrollment Monitoring

Implement procedures to ensure any adverse legal actions or changes in provider status are reported within the new 30-day window. Review enrollment status proactively and verify that compliance documentation is up to date. Consider regular internal audits of documentation, OASIS-submissions, and patient assessments across payers.

What Should Home Health Agencies Expect Going Forward?

Agencies should prepare for increased regulatory scrutiny, ongoing recalibrations, and evolving value-based payment models. Compliance, accurate documentation, robust quality reporting, and efficient clinical workflows will be critical to maintain financial stability and eligibility under Medicare and other payers. Agencies that adapt early will be better positioned amid shifting payment and regulatory landscapes.

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