The Centers for Medicare & Medicaid Services (CMS) today released its proposed rule for the Calendar Year (CY) 2026 Home Health Prospective Payment System (HHPPS) payment rate update, which includes a -6.4% aggregate payment update. If finalized, this would reduce Medicare payments to home health agencies by an estimated $1.135 billion compared to 2025.

The proposal includes a 2.4% annual payment update, offset by a -3.7% permanent behavioral adjustment, a -4.6% temporary adjustment, and a -0.5% decrease related to updates to the fixed-dollar loss ratio for outlier payments. CMS is also proposing recalibration of the Patient-Driven Groupings Model (PDGM) case-mix weights and updates to functional impairment levels, comorbidity adjustment subgroups, and Low Utilization Payment Adjustment (LUPA) thresholds.

Additionally, the proposed rule would broaden face-to-face encounter practitioner eligibility to align with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, allowing non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, and physician assistants) to perform these encounters even when they are not the certifying provider. CMS also proposes implementing a revised Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS®) survey beginning with the April 2026 sample month and updates to require all-payer data submission of Outcome and Assessment Information Set (OASIS) data.

Other provisions include changes to the Home Health Quality Reporting Program (HHQRP) Model measures, as well as updates to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) accreditation requirements, competitive bidding program rules, and Medicare provider enrollment standards.

• CMS Proposed Rule
• CMS Fact Sheet

CMS states these adjustments are necessary to account for differences between assumed and actual behavior changes since PDGM implementation in 2020. However, HCAF is deeply concerned about the impact of these proposed cuts on Florida’s home health providers and the patients they serve.

What’s Next?

The proposed rule is open for public comment and is expected to be finalized in the fall. HCAF will advocate strongly against these cuts to protect access to care and ensure provider stability. Please stay tuned for the deadline to submit your comments to CMS and make your voice heard.

Additionally, we will provide a detailed overview of the final rule at HomeCareCon 36th Annual Conference & Trade Show, taking place July 22-25 in Orlando. The session will feature insights from Dr. Steve Landers, CEO of the National Alliance for Care at Home, along with other experts discussing the proposal’s implications. Register today to stay informed about how these changes could impact your agency.

Join Us in Washington to Advocate for Home Care

We encourage all Florida home care advocates to participate in the National Alliance for Care at Home Advocacy Week, taking place September 8-11 in Washington, D.C. This is a critical opportunity to meet with congressional staff and advocate against these proposed cuts and other threats to home-based care.

Click here to register now.

Thank you for your continued support for HCAF. We will keep advocating to protect your agency and the patients you serve.