Federal Updates for Home Health and Hospice
(Dec. 16, 2025) Please see the following updates from LeadingAge National:
CMS Posts Home Health Quality and Star Rating Preview Reports for January 2026. Due to the lapse in federal appropriations, scheduled data refreshes and other routine updates were temporarily paused. With the resumption of government operations on November 13, the HHA Provider Preview Reports updates are now being released in iQIES. These reports contain provider performance scores for quality measures to be published on Care Compare in January 2026. Data contained within the Provider Preview Reports are based on quality assessment data submitted by HHAs from Quarter 2, 2024 through Quarter 1, 2025. The data for the claims-based measures will display data from Quarter 1, 2023 through Quarter 4, 2024 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2022 through Quarter 4, 2024 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2024 through Quarter 4, 2024 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 3, 2024 through Quarter 2, 2025. The Preview Reports for the January 2026 release include one new OASIS-based measure, COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date, based on quality assessment data from Quarter 1, 2025. This measure was proposed for removal in the CY2026 Home Health Rule which has not yet been published.
Home Health October Care Compare Refresh Now Live! Due to the government shutdown, scheduled data refreshes from the Centers for Medicare and Medicaid Services (CMS) were temporarily paused. With the resumption of government operations on November 13, these updates are being released. Effective November 20, 2025, the October 2025 refresh of the Home Health Quality Reporting Program is now available on the compare tool on Medicare.gov and Provider Data Catalog (PDC). The data are based on quality assessment data submitted by home health agencies (HHAs) from Quarter 1, 2024 through Quarter 4, 2024. The data for the claims-based measures will display data from Quarter 1, 2023 through Quarter 4, 2024 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2022 through Quarter 4, 2024 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2024 through Quarter 4, 2024 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 2, 2024 through Quarter 1, 2025. However, CMS shares that due to technical issues that affected two quality measures, CMS has decided to suppress the measure results for the Transfer of Health Information to the Provider and Discharge Function Score measures (which is used in the Home Health Value Based Purchasing Program) for the October 2025 release. Reporting on the two measures will resume with the next refresh in January 2026.
Veteran’s Affairs Releases CY ’26 Fee Schedule. On November 25, the VA released the fee schedule outlining the VA’s Payment rates for provision of contracted service. Of primary interest for adult day services providers are codes: S5102 – Main per diem code, S5105 – Additional services code, S5101 – Half day per diem code, T2003 – Transportation code – one-way. Rates are geographically variable and will be effective January 1, 2026. The rates included in the fee schedule indicate rates that will be reimbursed for authorized services delivered to eligible veterans and do not imply payment for services delivered without authorization or eligibility determined in advance. More information on the VA rate setting process, eligibility for payment, and the updated fee schedule can be downloaded here.
Administration Outlines its MA Direction for CY2027 and Beyond
The Contract Year 2027 Policy and Technical Changes to Medicare Advantage, Medicare Prescription Drug Benefit, Medicare Cost Plan, and Programs of All-Inclusive Care for the Elderly Programs (CMS-4212-P) indicates the Trump Administration is still looking to make more changes to the Medicare Advantage (MA) program in 2027. CMS is proposing changes to the MA star rating system and to add a new special enrollment period (SEP) to allow enrollees to make mid-year coverage changes – to another MA plan or to return to traditional Medicare – when one or more of their providers will no longer be in their plan provider network in the middle of the plan year.
CMS is also seeking input from stakeholders through multiple Requests for Information (RFIs) within the proposed rule that seek to focus on “maximizing program value for beneficiaries and taxpayers” and promote integration. One of the RFIs is interested in ideas for enhancing competition within MA through changes to plan risk adjustment and quality bonus payments, acknowledging that smaller, newer plans or those with fewer resources may be at a disadvantage over larger national plans. Another RFI will examine ideas for ensuring dual eligibles who enroll in chronic condition special needs plans (SNPs) and institutional SNPs also benefit from integrated Medicare and Medicaid benefits like those in Dual Eligible SNPs. The input will inform future policy decisions of the administration including both future regulations and possible future CMMI models. CMS is also asking again for additional ideas for streamlining regulations and reducing administrative burden in Medicare.
LeadingAge will be reviewing the proposed rule in the coming days and will provide a more detailed analysis the week of December 1. The proposed rule will be published on November 28, 2025, with comments due January 26, 2026.
CMS Adds Hospice Billing Rejection Edit to Hospital In-Patient and Out-Patient Services. In a November 20 Change Request (CR 14219) the Centers for Medicare and Medicaid Services instructed Part A/B Medicare Administrative Contractors (MACs) to implement new system edits which will automatically compare the primary diagnosis codes on hospital inpatient and outpatient claims with the hospice claim's primary diagnosis codes. The edit will deny hospital inpatient and outpatient claims when there is a hospice claim for the same Medicare beneficiary within the same covered period with condition code 07 with same primary diagnosis. This edit is in response to concerns first raised in a 2024 Office of Inspector General (OIG) report on outpatient services provided to hospice enrollees. The report identified improper payments for services provided to hospice enrollees related to their terminal illness which were already covered under the hospice benefit. In these instances, the services should have been provided directly by the hospices or under arrangement with the hospice and the hospital. The edit will be effective April 1, 2026 and CMS plans to issue additional education for providers to comply with billing expectations.
LeadingAge and Hospice Groups Ask CMS to Waive HOPE Timeliness Requirement. In a November 24, 2025, letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Oz, LeadingAge along with the national Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation request CMS waive the Hospice Outcomes and Patient Evaluation (HOPE) timeliness submission requirement for the first quarter post-implementation. The letter argues that simultaneous launch of the HOPE tool and migration to iQIES coincided with the first day of the government shutdown which led to reduced Help Desk responses to fatal errors and rejections, configuration issues beyond providers' control, and absence of real-time problem resolution. The consequence of adverse outcomes cannot be understated. The failure to comply with requirements of the Hospice Quality Reporting Program to submit 90% of patient records carries a 4% annual payment update reduction risk. Negative financial consequences for hospice providers is largely dependent this quarter not only on the success of two transitions—iQIES and HOPE—that are not within their control but also during a uniquely challenging government shutdown. LeadingAge has repeatedly advocated for waiving the 90% reporting threshold during the transition to HOPE. The impact of the government shutdown only exasperates hospices' compliance risks.
CMS Posts Hospice Quality Preview Reports for February 2026. Due to the lapse in federal appropriations, scheduled data refreshes and other routine updates were temporarily paused. With the resumption of government operations on November 13, the Hospice Provider Preview Reports are now being released on CASPER. These reports contain provider performance scores for quality measures to be published on Care Compare in February 2026. In the Provider Preview Reports, assessment-based measure scores are based on HIS data submitted by hospices from Quarter 2, 2024 through Quarter 1, 2025. CAHPS measure scores are based on CAHPS data submitted from Quarter 2, 2023 through Quarter 1, 2025. CAHPS Star Ratings are calculated based on data from Quarter 2, 2023 through Quarter 1, 2025. The claims-based measures reflect claims data collected from Quarter 1, 2023 through Quarter 4, 2024.
Contact: Meg Everett, meverett@leadingageny.org