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.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
2026-04467 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
This correction fixes some missing labels in important tables from the 2027 health insurance rules under the Affordable Care Act. It mainly affects insurance companies and people using marketplace plans by clarifying how risk and payments are calculated. These fixes take effect right away on March 6, 2026, ensuring everyone has clear info before the 2027 plan year starts.
2025-23081 — Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2026 and Updates to the IRF Quality Reporting Program; Correction
This correction fixes some math and typo mistakes in the Medicare payment rules for inpatient rehab facilities starting October 1, 2025. It mainly affects rehab centers by updating their payment rates and quality reporting details to be fair and accurate. These changes ensure providers get the right money and info for the 2026 fiscal year.
2025-22543 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Medicare is updating its payment plans to help more people get organ transplants through the Increasing Organ Transplant Access (IOTA) Model starting in Performance Year 2. These changes affect hospitals and doctors who work with Medicare patients needing transplants, aiming to improve care and save lives. Comments on the proposed rule are open until February 9, 2026, so stakeholders can share their thoughts before it’s finalized.
2025-21767 — Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies
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 providers will see new rules for quality reporting and value-based programs, while suppliers must meet updated accreditation and enrollment standards. These changes affect patients, providers, and suppliers, with payment updates and new deadlines kicking in early next year.
2025-21458 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some technical mistakes in the Medicare payment rules for 2026, especially about payments for skin substitutes. It affects doctors, Medicare patients, and providers by clarifying how certain payments work starting November 28, 2025. No big changes in money, just important corrections to keep things running smoothly.
Previous / Next Documents
Previous: 2025-12317 — Prohibiting Illegal Discrimination in Registered Apprenticeship Programs
The Department of Labor wants to make registered apprenticeship programs fairer and easier to run by removing some confusing and unlawful rules. This change helps program sponsors while keeping strong protections against discrimination for apprentices and applicants. The update aims to simplify things soon, with no extra costs for those involved.
Next: 2025-12368 — Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model
Starting in 2026, Medicare is updating how it pays for kidney dialysis and care for people with serious kidney problems. These changes affect patients with end-stage kidney disease and those with sudden kidney injuries, aiming to improve care quality and payment fairness. Some programs will be updated or ended, so providers and patients should get ready for new rules and payment rates.
Take It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in