The VBP Clock Is Ticking: How to Improve Quality Scores [Free Webinar]
On November 28, 2025, CMS released the CY 2026 Home Health Prospective Payment System Final Rule (HH PPS)1—one of the most highly anticipated and consequential updates for care-at-home providers of the year.
While CMS made notable changes in response to industry concerns, the rule still results in a net payment reduction and ushers in several operational, clinical, and compliance impacts for agencies nationwide.
Below, we break down the major changes and what they mean for home health organizations navigating an already strained landscape.
CMS finalized a 1.3% overall decrease in home health payments for 2026. This reflects:
Net result: an estimated $220 million decrease in aggregate payments compared to 2025.
While CMS did scale back cuts from the original proposed rule of 6.4%, industry leaders, including the National Alliance for Care at Home2, warn that continued reductions may further limit patient access and contribute to ongoing agency closures, especially in rural and underserved communities.
CMS finalized the last of the PDGM-driven permanent adjustments required by law, applying a –1.023% permanent cut in 2026.
This adjustment reflects CMS’s determination of differences between assumed and actual behavioral changes from 2020-2022. CMS acknowledged that post-2022 behavior shifts may be influenced by factors beyond PDGM, such as:
This recognition led to a substantially lower final cut than original proposed -4.059%. Still, these reduced cuts exacerbate already compounding financial pressures on home health providers.
CMS finalized a –3% temporary adjustment for 2026 to recoup what it considers overpayments from 2020–2022. The temporary adjustment amount now totals $4.76 billion.
CMS will continue analyzing claims through 2026, meaning temporary adjustments could persist for multiple years unless Congress intervenes.
Using CY 2024 data, CMS will update:
These refinements reflect ongoing shifts in patient acuity, utilization, and coding patterns. Agencies should expect noticeable impacts on revenue cycle forecasting and visit utilization strategies.
CMS updated its face-to-face encounter regulation to fully align with CARES Act provisions. Under the final rule, physicians, NPs, CNSs, and PAs may perform the face-to-face encounter:
This clarification removes previous ambiguities and may help streamline face-to-face encounter compliance.
The 2026 rule finalizes several QRP updates:
CMS is also providing a summary of feedback on future directions, including digital quality measurement; FHIR standards; and future HHQRP measure concepts like interoperability, cognitive function metrics, nutrition, and patient well-being.
Beginning in April 2026, HHVBP measure updates include:
Removed (due to HHCAHPS redesign):
Added:
CMS is also implementing updated measure weights and adding a new removal factor for measures that are no longer feasible to implement.
CMS finalized several actions designed to curb fraud, waste, and abuse:
These changes increase compliance risk and reinforce the need for rigorous enrollment monitoring.
Home health agencies that provide DMEPOS should anticipate the most sweeping oversight updates since 2006:
CMS expects these provisions to strengthen program integrity, ensuring greater protection for Medicare beneficiaries and taxpayers from unqualified DMEPOS suppliers.
Additional updates include:
The 2026 final rule reflects CMS’s responsiveness to industry feedback, particularly in scaling back the permanent adjustment and acknowledging limitations in its methodology. The approximately $915 million swing from the proposed rule to final rule represents meaningful progress driven by strong home health advocacy efforts.
Yet the overall impact remains concerning for providers. As the National Alliance for Care at Home highlights in their response to the final rule:
For patients, this translates to bigger costs, longer wait times, higher rates of readmission and ED use, and fewer opportunities to receive clinically appropriate care at home.
Safeguarding the future of home health will require continued advocacy and legislative action to modernize payment methodology, protect patient access, and stabilize the care-at-home ecosystem.
Maxwell TEC supports home health organizations through these shifting regulations, tighter margins, and increased expectations for data-driven performance. Our proven technology and strategic solutions help agencies:
As the regulatory landscape becomes more complex, Maxwell TEC helps home health agencies stay compliant, competitive, and patient-centered—so they can continue delivering exceptional care at home.
This blog was originally published as "Key Takeaways from the CMS CY 2025 Home Health Final Rule" on 11/5/2024, for Maxwell Healthcare Associates. The Maxwell TEC editorial team has since updated this article to reflect the 2026 final rule.