FOR IMMEDIATE RELEASE
HealthBridge Releases Comprehensive Analysis of the CY 2026 CMS Home Health PPS Final Rule, Highlighting Key Payment, Quality, and Regulatory Changes for Home Health Agencies
Los Angeles, CA — December 2, 2025 — HealthBridge, a leading provider of healthcare compliance, quality assurance, and operational consulting services, has published a detailed analysis of the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2026 Home Health Prospective Payment System (PPS) Final Rule, outlining essential updates that will significantly impact home health agencies nationwide. The Final Rule includes payment reductions, PDGM refinements, quality reporting updates, and expanded program integrity provisions that agencies must implement ahead of January 1, 2026.
Although CMS initially proposed an approximate $60 per 30-day period reduction, the Final Rule establishes a smaller—yet still consequential—net decrease of roughly $19 per 30-day period, following permanent, temporary, and technical adjustments. CMS attributes this revised reduction to updated 2024 data reflecting more accurate behavioral changes under the Patient-Driven Groupings Model (PDGM).
Overall, CMS projects a –1.3% ($220 million) decrease in aggregate Medicare home health payments in CY 2026.
Key Provisions Highlighted by HealthBridge
Payment Rates & PDGM Adjustments
The Final Rule finalizes several adjustments affecting agency reimbursement, including:
–1.023% permanent behavioral adjustment
–3.0% temporary adjustment applied for CY 2026
Updated case-mix weights, comorbidity groupings, functional impairment levels, and LUPA thresholds
HealthBridge notes that these updates may influence reimbursement differently across agencies based on clinical mix and operational patterns.
Home Health Quality Reporting Program (HH QRP) Updates
CMS finalized multiple changes to the HH QRP, including:
Removal of the COVID-19 vaccination reporting measure
Removal of four standardized patient assessment data elements (SPADEs)
Implementation of a revised HHCAHPS® survey starting April 2026
Streamlined reconsideration and extraordinary circumstance exception processes
HealthBridge emphasizes the importance of updated staff training and internal auditing to ensure compliance with evolving reporting measures.
Home Health Value-Based Purchasing (HHVBP) Program Changes
The 2026 Final Rule reshapes the HHVBP program through:
Removal of three HHCAHPS®-based measures
Addition of four new measures, including the Medicare Spending per Beneficiary – PAC (MSPB-PAC) measure
Introduction of three new OASIS-based measures focused on:
CMS also adjusted scoring weights across categories to place greater emphasis on outcomes, patient engagement, and cost efficiency.
Conditions of Participation (CoPs) Clarification
A major regulatory clarification confirms that OASIS reporting applies to all skilled patients, regardless of payer source.
This includes Medicare, Medicaid, commercial insurance, worker’s compensation, and private pay.
HealthBridge advises agencies to audit intake processes and ensure OASIS compliance for all skilled admissions to avoid Condition-level survey deficiencies.
Provider Enrollment & Program Integrity Enhancements
CMS expanded its oversight and enforcement capabilities through:
Broader authority to deny, revoke, or deactivate provider enrollment
Reduced reporting timeframe for adverse legal actions from 90 days to 30 days
Additional scenarios in which CMS may grant retroactive effective dates
Agencies are strongly encouraged to strengthen their internal monitoring and enrollment workflows.
HealthBridge Statement on the Final Rule
“While the finalized payment reduction is significantly lower than CMS initially proposed, the CY 2026 Home Health Final Rule still represents a major shift in financial and regulatory expectations for home health agencies,” said HealthBridge Leadership. “Agencies must proactively strengthen documentation quality, OASIS accuracy, quality reporting, and operational readiness to remain compliant and financially viable under these updated requirements.”
HealthBridge’s analysis highlights the need for agencies to reassess:
PDGM financial modeling
HHVBP performance strategies
Documentation and OASIS accuracy
QAPI program enhancements
Regulatory reporting workflows
Provider enrollment oversight
HealthBridge Support for Home Health Agencies
HealthBridge remains committed to supporting home health agencies through the transition into CY 2026. The organization offers:
Comprehensive quality assurance chart reviews
Mock surveys and full survey-readiness preparation
Medicare CoP compliance consulting
OASIS audits and staff training
Operational and regulatory guidance to address deficiencies and improve outcomes
For agencies seeking expert support in navigating the CY 2026 Final Rule, HealthBridge provides turnkey solutions to ensure compliance, operational stability, and improved performance under evolving federal guidelines.
