Home Health PPS

July 18, 2025

AT A GLANCE

The Centers for Medicare & Medicaid Services (CMS) June 30 issued its proposed rule for the calendar year (CY) 2026 home health (HH) prospective payment system (PPS). Comments are due Sept. 2, and a final rule is expected around Nov. 1. New policies would generally be effective Jan. 1, 2026.

Key Highlights

The proposed rule would:

Reduce net HH payments by an estimated 6.4%, or $1.135 billion, compared to CY 2025 payments. This reduction includes:
- A 3.2% market basket update, reduced by a 0.8% productivity adjustment.
- A permanent behavioral adjustment (applied to the 30-day episode payment rate only) that is expected to reduce payments by 3.7%.
- A temporary behavioral adjustment (applied to the 30-day episode payment rate only) that is expected to reduce payments by 4.6%.
- An estimated 0.5% decrease in payments due to changes in outlier payments.
Allow the face-to-face visit to be performed by any physician or non-physician practitioner, regardless of which practitioner certifies the need for HH services.
Remove a measure on patient COVID-19 vaccination and four patient assessment data elements related to social drivers of health.
Adopt a revised HH Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and related measures.
Adopt one claims-based and three Outcome and Assessment Information Set (OASIS) based measures to the HH value-based payment (VBP) program.
Make several updates to the Medicare provider enrollment and accreditation regulations for durable medical equipment providers and suppliers.