2026 Home Health Payment Rule Analysis Available
(Dec. 16, 2025) The Centers for Medicare and Medicaid Services (CMS) finalized the Calendar Year (CY) 2026 Home Health Prospective Payment Rule on Nov. 28th. The final rule resulted in a net positive change of $915 million between the proposed rule’s rate reduction and the final version. The final CY 2026 Home Health payment update includes an estimated 2.4% increase ($405 million increase), which is offset by an estimated 0.9% decrease that reflects the final permanent adjustment ($150 million decrease), an estimated 2.7% decrease that reflects the final temporary adjustment ($460 million decrease), and an estimated 0.1% decrease that reflects the updated fixed-dollar loss (FDL) ratio for outlier payments ($15 million decrease). The proposed 6.4% cut would have resulted in a $1.135 billion reduction for home health services. The final rate will impose a $220 million cut, which represents a 1.3% cut compared to last year's payment rule.
Some other components of the rule include:
- CMS is finalizing a proposal to simplify language regarding which allowed practitioners can conduct the face-to-face requirement. These revisions will address concerns that the current regulations do not align with the Coronavirus Aid, Relief, and Economic Security (CARES) Act language. This is a welcome change to regulation and consistent with LeadingAge National’s deregulation request that CMS align the face-to-face requirements with the CARES Act language.
- Removes four new social determinants of health (SDOH) items which were adopted in CY 2025 for the Outcome and Assessment Information Set (OASIS), along with the COVID-19 Vaccine: Percent of Patients Who Are Up to Date measure which was adopted in CY 2024.
- Modifies the Home Health Value-Based Purchasing (HHVBP) Model by including more measures, updated low-utilization payment adjustment (LUPA) thresholds, and a recalibration of Patient-Driven Groupings Model (PDGM) case weights.
- LeadingAge National advocated for reversing the all-payer OASIS collection requirements. Unfortunately, CMS’s decision to codify collection in the Conditions of Participation (CoPs) indicates that the all-payer collection policy will remain in place.
- Agencies have more opportunities to file requests for extension of non-compliance reconsideration requests to avoid annual payment update penalties.
Please see LeadingAge National's analysis of the rule here.
Contact: Meg Everett, meverett@leadingageny.org