CMS Releases Calendar Year 2026 Home Health Proposed Rule

(from Alliance Daily)

On June 30, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule. CMS has also released a fact sheet accompanying the proposed rule. The National Alliance for Care at Home (Alliance) issued a statement in response. “. . . If implemented, this rule will further cut the Medicare benefit and have catastrophic impacts on home health care access by forcing providers to close their doors, expanding existing and creating new home health care deserts, and leaving patients without the essential care they need. . . . Since the inception of the new payment system in 2020, total Medicare home health expenditures have declined year-over-year, a fact that is directly at odds with CMS’s assertion that aggregate expenditures under the new system are higher than they otherwise would have been prior to the 2020 changes.”

Key Provisions Include:

·     For CY 2026, CMS proposes to reduce payments to HHAs by 6.4%, or $1.135 billion, which reflects the impact of a 2.4% increase in payments due to the statutorily-required annual payment update, a 3.7% reduction in payments due to a proposed budget neutrality permanent adjustment, a 4.6% reduction in payments due to a proposed budget neutrality temporary adjustment, and a 0.5% decrease in payments related to a proposed update to the Fixed-Dollar Loss (FDL) ratio.

·     Proposes changes to who may conduct the Face-To-Face encounter policy.

·     Updates the Home Health (HH) Quality Reporting Program (QRP) by removing COVID-19 and several assessment items.

·     Proposes a new Home Health Consumer Assessment of Healthcare Providers and Systems® (HHCAHPS) survey beginning April 2026.

·     Includes an update to the Home Health Value Based Purchasing Program (HHVBP) to reflect the new HHCAPHS survey and proposes four new measures.

·     Proposes Medicare provider enrollment changes.

·     Includes three Requests for Information - Advance Digital Quality Measurement, Future Quality Measure Concepts, and Changes to the HHVBP.

View the National Alliance's official statement

Read the National Alliance's full analysis

Thanks

Carol Hudspeth

Executive Director