NOW AVAILABLE: The CMS CY 2026 Home Health Proposed Rule

by Marian Essey, RN, BSN, COS-C

On June 30, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule. This proposed rule updates HHA Medicare payment rates, Home Health Quality Reporting Program (HHQRP) requirements, Home Health Value-based Purchasing (HHVBP) Model requirements, and other Medicare policies.

In addition, the proposed rule requests for information (RFIs) on multiple topics. The following highlights are the proposed updates to the HHQRP and HHVBP.

Proposed Changes: HHQRP

COVID-19 Measure Removal – CMS is proposing to remove the COVID-19 Vaccine: Percentage of Patients Who Are Up to Date Measure and the corresponding Outcome and Assessment Information Set (OASIS) data element.

Removal of OASIS Items – CMS is also proposing the removal of four assessment items in the standardized patient assessment: one Living Situation item, two Food items, and one Utilities item.

Reconsideration Policy Change – This rule also proposes revising the reconsideration policy to allow providers to submit a request for reconsideration of an initial determination of noncompliance if they can demonstrate compliance.

Home Health CAHPS – CMS proposes implementing a revised Home Health Consumer Assessment of Healthcare Providers and Systems® (HHCAHPS) survey beginning with the April 2026 sample month.

All-Payer Regulatory Text Change to Home Health Conditions of Participation (COPs) – Finally, this rule also proposes updates to the regulatory text to account for all-payer data submission of OASIS data.

Requests for Information: HHQRP

- CMS is seeking information on a change to the final data submission deadline period from 4.5 months to 45 days.
- CMS is also seeking feedback on the digital quality measurement (dQM) transition for HHAs and the adoption of health information technology (IT), and standards including Fast Healthcare Interoperability Resources (FHIR).
- CMS is seeking input on future HH QRP quality measure concepts of interoperability, cognitive function, nutrition, and patient well-being.

Proposed Changes: HHVBP Applicable Measure Set

The following summarizes the proposed changes to the HHVBP Applicable Measure Set and HHVBP RFIs.

Home Health CAHPS – Beginning April 2026, CMS is proposing changes to the HHCAHPS survey. These changes affect the survey questions used to calculate three measures that are currently used in the expanded HHVBP Model. Due to the proposed changes to the HHCAHPS survey, CMS is proposing to remove these measures:

- - Care of Patients
  - Communications between Providers and Patients
  - Specific Care Issues

Addition of Measures – CMS is also proposing the addition of four measures to the applicable measure set. This includes three OASIS-based measures related to bathing and dressing, and one claims-based measure, the Medicare Spending per Beneficiary for the Post-Acute Care (PAC) setting measure.

Measure Weights – Due to the proposed changes to the Model’s applicable measure set, CMS is proposing to alter the current weights of individual measures and measure categories.

Measure Removal Factor – CMS is proposing to add and codify an additional measure removal factor at § 484.358, Factor 9: It is not feasible to implement the measure specifications.

Requests for Information: HHVBP – The proposed rule includes an RFI that would build on input from the expanded HHVBP Model’s Implementation and Monitoring technical expert panel (TEP). CMS is asking for feedback about the addition of a respecified Falls with Major Injury measure as well as two potential changes to the HHCAHPS survey-based measures scoring rules and applicable measure set as they relate to the expanded HHVBP Model.