Home Health Proposed Final Rule CY 2026
CMS issued the proposed home health rule (for Calendar Year 2026) which includes a proposed 6.4%
reduction in home health payments—let’s review what you need to know…
CY 2026 Home Health Payment Update (Proposed)
- Payment rate cut: CMS proposes a 6.4% reduction in home health payments, equivalent to about $1.13 billion less compared with 2025.
- This includes:
- A 3.2% market basket increase, offset by a 0.8% productivity cut.
- A 4.1% permanent behavioral adjustment (correcting for PDGM-related overpayments).
- A 5.0% temporary reduction to recoup previously overpaid funds.
- A 0.5% outlier payment cut
- This includes:
- Scope beyond payments:
- Removal of some Home Health Quality Reporting (HH QRP) measures—like the COVID-19 vaccination metric.
- Elimination of certain standardized patient assessment items tied to living conditions and utilities.
- Introduction of four new functional-improvement measures (e.g., dressing, bathing) in the Home Health Value-Based Purchasing program.
- The comment period runs through September 2, 2025 (60 days from publication on June 30).
- Change the face-to-face regulation to allow physicians, in addition to NPs, CNSs, and PAs, to perform the face-to-face encounter regardless of whether they are the certifying practitioner or whether they cared for the patient in the acute or post-acute facility from which the patient was directly admitted to home health and who is different from the certifying practitioner.
- CMS is proposing changes to the HHCAHPS survey. These changes impact 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
- This HHCAHPS domain measures how well patients feel their care needs are addressed by the home health agency.
- Communications between Providers and Patients
- Measures how well home health staff:
- Explain things clearly
- Listen carefully
- Treat patients with courtesy and respect
- Measures how well home health staff:
- Specific Care Issues measures
- How well patients feel the agency:
- Gave information about medicines
- Provided information on home safety
- Informed them about their care
- Addressed pain
- Helped them manage breathing
- Provided information about what to do if symptoms worsened
- How well patients feel the agency:
- Care of Patients
What You Should Know & Next Steps
- Key shifts in the CY 2026 proposed rule include much deeper cuts as compared to 2025, plus quality reporting and value-based care changes.
- Action window: CMS is accepting feedback through September 2, 2025.
- Industry implications: Many providers are concerned about access to care, post-hospital discharge and financial strain in the face of proposed cuts.
- Strategy: Review CMS’s full fact sheet and consider submitting comments.
CMS Proposed Rule Fact Sheet
The proposed rule can be downloaded from the Federal Register:
https://www.federalregister.gov/d/2025-12347
Comments may be submitted using the link below:
Medicare Regulatory Relief | CMS
Contact Proactive to ensure efficiency of operations and effective leadership support as you prepare for the possible impacts of the CY 2026 Proposed Rule!
Written By:
Nichole McClain, RN
Principal Consultant of Home Health Services
Proactive Medical Review
Contact Proactive to learn more about Five-Star Improvement support services and develop a road map to Five-Star success in 2025.