On June 30, Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Home Health Prospective Payment System (HH PPS) proposed rule . This annual rule outlines significant changes to Medicare home health payment policies, including rate adjustments, Patient-Driven Groupings Model (PDGM) recalibration, quality reporting updates and value-based purchasing modifications.  For home health agencies (HHAs), this year’s proposed rule carries major financial and operational implications. CMS estimates an overall $1.135 billion decrease in aggregate payments in CY 2026 compared to CY 2025, largely driven by permanent behavioral adjustments, temporary payment recoupments and changes to outlier payment thresholds.  In addition to payment updates, the rule introduces policy revisions to the Home Health Value-Based Purchasing (HHVBP) model, face-to-face encounter requirements, provider enrollment safeguards and durable medical equipment regulations.   Ove...

CMS’ proposed Calendar Year 2024 Medicare Home Health Prospective Payment System rule includes updates to: the Patient-Driven Groupings Model, Low Utilization Payment Adjustment thresholds, functional levels and comorbidity adjustment subgroups; estimated aggregate payments based on the 30-day payment rate to account for assumed versus actual behavior changes; the HH Value-Based Purchasing and Quality Reporting programs; home intravenous immune globulin items and services, and disposable negative pressure wound therapy device payment rates; medical equipment and supplies, including competitive bidding, as outlined by the Consolidated Appropriations Act of 2023; and provider and supplier enrollment requirements and oversight. The HH PPS rule also proposes to add a new Special Focus Program for low-performing hospices. CMS estimates that the rule will cut aggregate HH agency payments by $375 million nationally. This includes a -1.81% adjustment in the HH annual standard payment rate. Th...