Home Health VBP Changes for 2026: What Agencies Need to Know Now
The Home Health Value-Based Purchasing (HHVBP) Model continues to reshape how Medicare evaluates and pays home health agencies and 2026 marks one of the most impactful updates since nationwide expansion. CMS is doubling down on what matters most which is measurable patient outcomes and cost efficiency, while refining how patient experience is captured. These changes will directly influence future payment adjustments, making early preparation critical.
Here’s what’s changing and what agencies should do now.
A Refreshed VBP Measure Set for 2026
Beginning January 1, 2026, CMS finalized updates to the HHVBP measure set to better align with revised data collection tools and value-based care goals.
Measures Removed
Due to major updates to the HHCAHPS survey, CMS removed three patient experience measures from the VBP scoring model:
- Care of Patients
- Communications Between Providers and Patients
- Specific Care Issues
These measures previously made up a sizable portion of the performance score, and their removal represents a clear shift away from broad satisfaction metrics.
New Measures Added
To rebalance the model, CMS added four new performance measures:
- Medicare Spending per Beneficiary (Post-Acute Care)
A claims-based measure that evaluates cost efficiency after the patient receives home health services.
2–4. Functional Outcome Measures (OASIS-Based):
- Improvement in bathing
- Improvement in upper-body dressing
- Improvement in lower-body dressing
These additions reinforce CMS’ emphasis on functional improvement and clinical impact, not just visit completion.
Measure Weighting: Where Performance Really Counts Now
With the updated measure set, CMS also adjusted category weightings:
- OASIS-based measures: 40%
- Claims-based measures (including spending): 40%
- HHCAHPS patient experience: 20%
Only two HHCAHPS items remain in the VBP calculation:
- Overall rating of the agency
- Willingness to recommend the agency
Bottom line: Clinical documentation accuracy and functional outcomes now carry significantly more influence than before.
Why This Matters for Payment
HHVBP payment adjustments are applied two years after the performance year.
That means:
- 2026 performance impacts 2028 Medicare payments
- Strong outcomes today = stronger revenue later
- Poor documentation or missed functional improvement opportunities will show up financially
Agencies that fail to adapt may see negative payment adjustments, even if their census remains strong.
HHCAHPS Survey Changes Still Significant
Although fewer HHCAHPS measures remain in VBP scoring, patient experience is not going away.
CMS revised the HHCAHPS survey effective April 2026, which affects:
- Survey structure and scoring methodology
- How remaining experience measures are calculated
Agencies must ensure staff understand how communication, education, and professionalism still influence performance even if weighting has shifted.
What Home Health Agencies Should Do Now
To stay competitive under the 2026 VBP changes, agencies should:
- Validate functional scoring at SOC, ROC, and DC
- Train clinicians on consistent interpretation of bathing and dressing items
Focus on Functional Improvement
- Embed function-focused goals into care plans
- Use therapy and nursing collaboration intentionally
Monitor Cost & Utilization
- Watch hospitalizations, ER visits, and utilization patterns
- Collaborate with physicians to reduce avoidable spending
Prepare Leadership & QAPI Teams
- Update QAPI dashboards to reflect new measures
- Educate governing body members on VBP financial risk
The 2026 HHVBP updates signal a clear message from CMS. Home health success will be measured by what patients can do better and how efficiently agencies help them get there.
Agencies that invest now in outcomes-driven care, strong documentation, and proactive performance monitoring will be positioned to thrive in the next phase of value-based home health.
Contact Proactive Home Health Consulting for all of your Value Bases Purchasing support needs including OASIS review, ICD-10 Coding. documentation review and training.
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.