Medicare Tweaks Home Health Payments and Quality Rules for 2026
Published Date: 7/2/2025
Proposed Rule
Summary
Starting in 2026, Medicare is updating how it pays for home health care and durable medical equipment, making sure payments match patient needs better. Home health agencies, equipment suppliers, and providers will see changes in payment rates, quality reporting, and enrollment rules that could affect their money and operations. These updates aim to improve care quality and keep the system fair and efficient.
Analyzed Economic Effects
7 provisions identified: 0 benefits, 0 costs, 7 mixed.
CY2026 Home Health Payment Rate Update
Starting for Calendar Year 2026, Medicare proposes routine updates to the Home Health Prospective Payment System (HH PPS) payment rates. These updates change how Medicare pays home health agencies for services during CY 2026.
Recalibration of Case-Mix and LUPA Thresholds
For CY 2026 the rule proposes recalibrating case-mix weights and updating functional impairment levels, comorbidity subgroups, and low-utilization payment adjustment (LUPA) thresholds. These changes alter how individual patient needs are weighted in payment calculations for home health episodes in 2026.
HH Quality Reporting and VBP Model Changes
The proposal would change the Home Health Quality Reporting Program (HH QRP) and the expanded Home Health Value-Based Purchasing (HHVBP) Model requirements for CY 2026. These changes affect reporting obligations and value-based payment model participation for home health providers.
DMEPOS Competitive Bidding Program Updates
The rule would update the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) for CY 2026. These updates affect suppliers participating in Medicare's competitive bidding for DMEPOS items.
Permanent and Temporary Behavior Adjustments
The proposal includes permanent and temporary behavior adjustments related to the HH PPS for CY 2026. These adjustments are intended to modify payment behavior under the home health payment system.
Face-to-Face Encounter Policy Changes
The proposed rule would change the Medicare face-to-face encounter policy for home health. These policy changes affect provider documentation and verification requirements related to clinical encounters.
DMEPOS Accreditation, Payment, and Enrollment Updates
The proposal includes updates to DMEPOS accreditation requirements, supplier conditions of payment, and provider and supplier enrollment requirements, along with a technical change to home health conditions of participation. These changes affect supplier accreditation, payment conditions, and enrollment in Medicare.
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Key Dates
Department and Agencies
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