Home Health PPS

December 1, 2025

AT A GLANCE

The Centers for Medicare & Medicaid Services (CMS) Nov. 28 issued its calendar year (CY) 2026 final rule for the home health (HH) prospective payment system (PPS). The agency included in this rule several changes affecting durable medical equipment providers. This regulatory advisory reviews highlights of this rule. Changes will generally be effective Jan. 1, 2026.

Key Highlights

As finalized, the rule:

Reduces HH payments by an estimated 1.3%, or $220 million, in CY 2026 relative to CY 2025. This includes a 3.2% market basket update, reduced by a 0.8% productivity cut, a 3.6% reduction due to budget neutrality requirements for the Patient-driven Groupings Model (PDGM) and a 0.1% reduction related to high-cost outlier payments.
Removes a measure on patient COVID-19 vaccination and four patient assessment data elements related to social drivers of health.
Adopts a revised Consumer Assessment of Healthcare Providers and Systems Home Health Care Survey (HHCAHPS survey) and related measures.
Adopts one claims-based and three Outcome and Assessment Information Set- (OASIS-) based measures to the HH Value-Based Purchasing (HHVBP) model.
Makes several updates to the Medicare provider enrollment and accreditation regulations for durable medical equipment providers and suppliers.