CHAPcast by Community Health Accreditation Partner
CHAPcast: Your Trusted Partner on the Go
For over 60 years, CHAP has been leading the way in home and community-based care, and now CHAPcast is leveling up! With a dynamic new format, co-hosts Jennifer Kennedy and Kim Skehan bring their expertise, passion, and a touch of personality to every episode.
Get ready for deeper dives into the issues that matter—breaking down policy updates, exploring cutting-edge trends, and sharing practical tools to help you thrive. Fresh perspectives and actionable insights you can use right away.
Whether on a commute, in the office, or just catching a moment to yourself, CHAPcast is here to keep you informed, inspired, and ahead of the curve.
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CHAPcast by Community Health Accreditation Partner
2026 Home Health Proposed Rule + Payment Changes
A massive regulatory overhaul looms on the horizon for home health agencies. The proposed Calendar Year 2026 Home Health Payment Update rule spans nearly 600 pages, packed with changes that extend far beyond payment adjustments.
- Proposed expansion of face-to-face encounter policy to allow not just physicians but also NPs, CNSs, and PAs to perform encounters regardless of prior patient relationship
- CMS plans to remove COVID-19 vaccine reporting measure and four social determinants of health assessment items from OASIS data collection
- Proposed shorter HHCAHPS survey implementation beginning April 2026 with fewer questions
- Potential reduction in data submission timeframes from 4.5 months to 45 days to improve measure timeliness
- Updates to Home Health Value-Based Purchasing including measurement changes and reweighting of components
- Technical updates to Conditions of Participation text to accommodate all-payer OASIS data submission
- Multiple requests for information on interoperability, wellness measures, and falls reporting
Comments on these proposed changes must be submitted to CMS by August 29th. The final rule is expected to be published in late October or early November.
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Greetings. I'm Jennifer Kennedy, the lead for compliance and quality at CHAP, and welcome to CHAPcast. Today we're going to be talking about the calendar year 2026 home health payment update rule and I shortened that title significantly because it is a long title for the rule. But today we're going to just focus on the home health provisions in this 591 of a rule, and I'm really so very happy to be talking about the home health provisions with my colleague and good friend, kim Skian, who is our vice president for accreditation. So, kim, wow, big rule.
Speaker 2:That's right and we've read plenty of them, right, Jennifer?
Speaker 1:Yeah, more than I can count. I think, and I think you know, for our purposes of doing what we do and serving our partners out in the CHAP community, is dividing this rule into just the home health provisions and then dealing with all of the DME provisions separately I think helps, or will help, providers get their head around what CMS has included in this rule. And you know, just to be honest, I'm sure providers are feeling overwhelmed just looking at this huge document, but it was overwhelming to read it for sure.
Speaker 2:Absolutely, and the only other thing I would add is that our focus is on the proposed regulatory and quality reporting changes. We will leave the financial analysis related to payment updates and PDGM changes to industry experts, such as the National Alliance for Healthcare at Home State Association and, again, industry consulting firms and experts, Just to provide further detail, because there are many changes associated with the financial impact as well that providers do need to ensure that they understand and review and understand the impact for their agencies.
Speaker 1:Yeah, I can't agree with you more. You know, we know that in this proposed rule there's a 6.4% permanent deduction, or a decrease in the rate for home health providers proposed for calendar year or fiscal year 2026. So that I mean it is significant and I think you're spot on with providers looking to national organizations as they unpack this rule and look at all of the financial parameters that are included and that will have a significant impact on home health providers in the space. We, as you said, kim, you know that's really not our scope here at CHAP, but it doesn't mean it's not important, for sure, absolutely. So let's talk about the things that are in our scope and that you know. We need to make sure providers understand what CMS is proposing. And the first thing I'd like to throw out there is the proposed changes to the face-to-face encounter policy.
Speaker 2:You know, I think that this is one of the positive proposed changes in the rule and I believe it will be largely welcomed by home health providers and advocates.
Speaker 2:In this change, cms is proposing to change the face-to-face regulation to allow, you know, the physicians in addition to physicians, nps, nurse practitioners, cnss, and physician's assistants or PAs to perform that face-to-face encounter and certification, regardless of whether they are the certifying practitioner or whether they cared for the patient in the acute or post-acute facility from which the patient was directly admitted to home health and who is different from the certifying provider.
Speaker 2:And this proposed change is going to align more closely with the CARES Act implemented as a result of COVID, by removing that limitation on which physicians are allowed to complete the face-to-face encounter and broadening the number of practitioners who can perform the face-to-face. It's important, though, to note that of the other requirements of the face-to-face, such as the timing and content, will not be changed under this rule and from a survey perspective, you know we don't review for the components or technical compliance with the face-to-face. However, we do know this is a significant compliance and payment issue that has resulted in agency in recruitment of funds due to technical denials identified during CMS or contractor audits. So this is a. It really is a meaningful if it's finalized, is a meaningful change for providers change for providers.
Speaker 1:I agree with that and I'm glad you said if finalized because everything that we're talking about today is in proposed status. It means that CMS put it out there we have a 60-day comment period, which that is on August 29th that comments have to be submitted to CMS. So CMS has to read all of those comments and weigh them and we could see changes from this proposed rule to the final. So thank you for putting it out there that if it's finalized we would march forth as it is written here or if they make any kind of tweaks to it based on comments, correct?
Speaker 2:Absolutely, and that's why comments are so important, both in support and also identifying any concerns. We want to make sure that, even if a provider supports the change, that you go on record and say that, that in the comment, that you do support that change and again, if you have other recommendations or concerns, to be able to highlight them as well. So, jennifer, in addition, I know we talked about face-to-face, but there are some significant proposed changes to the quality reporting program. I guess I wouldn't say changes, more significant tweaks to the quality reporting program. Do you want to discuss that just a little bit?
Speaker 1:Yeah, yeah, and I'm really happy to you know. Talk about quality, kim. As you know, at any time we could talk all day about quality. So CMS, in this rule, is proposing to remove the COVID-19 vaccine percentage of patients who are up to date with the measure and then that corresponding outcome and assessment information OASIS data element. Cms would continue to complete the, if this goes through, complete the OASIS item through April 2026. But it would seem that CMS is not finding the need to continue to have that as a measure.
Speaker 1:They're also proposing, kim, removal of four social determinants of health assessment items in that standardized patient data set. It is inclusive of one living situation item, two food items and one utilities items and we've been seeing this theme through rulemaking with the focus coming off of things like social determinants of health and health equity that have been very much up front in past years prior to this administration. So, given what the administration changed and refocused and retooling, we're seeing things like social determinants of health and health equity fall out of focus with CMS. Now they also are proposing some other things as it relates to quality and measures as well. Providers submit a request for reconsideration of an initial determination of noncompliance if they can give evidence and demonstrate full compliance. What are your thoughts on that?
Speaker 2:Yeah, this is another area that really what CMS is doing is codifying into regulation the process that is in place, that agencies can request a reconsideration for extraordinary services beyond the agency's control and that the reconsideration is submitted within 30 days of the notice of noncompliance.
Speaker 2:Jennifer, this is similar to what we see in hospice as well, where agencies come to the end of the reporting year and then they receive the letter that they're in non-compliance, meaning that they're below the 90% compliance threshold for submission of in home health OASIS assessment submission in the timeframe, oasis assessment submission in the timeframe or they have not participated in CAPS or submitted an exemption and largely the reasons that CMS will overturn.
Speaker 2:And I've had some past experience with working with agencies prior to being with CHAP working with agencies on these reconsiderations and generally when CMS says outside the agency's control, they don't mean situations where there was a change in staff or staff wasn't available or the OASIS error summary reports were not checked and fatal errors were not addressed, or if there's a technology you know concern, or if an organization is changing EMRs, typically they're looking at external factors such as weather-related or, you know, event-related situations that would have prohibited this submission, so there may be some additional leeway they're going to define, hopefully, in codifying this regulation, as far as extraordinary circumstances, but providers just need to be aware that, historically, the extraordinary circumstances are beyond what would have been beyond the agency's control.
Speaker 1:Yeah, you know what. I'm really glad that they define that, you know, because not all the time you're going to have a federal declaration of an emergency event. It may just happen at the state level, but it still interrupts and impacts operations, right? So that would be a perfect example to provide evidence that you had this event in your state, in your area, and you're requesting that reconsideration.
Speaker 2:And I would just say proactively and currently, organizations should be regularly reviewing their OASIS submission reports and the error summary to ensure that any fatal errors are addressed, to be able to be resubmitted so that the organization does remain in compliance.
Speaker 1:Yeah, couldn't agree more. So also, another inclusion is that CMS is proposing implementing a revised HHCAHPS survey and they're targeting that beginning with April 2026 sample month. So when we look at this, it is proposing to remove several items that they include in the multi-item specific care issues measure, and three of those items used in the specific care issues measure would remain in the HHCAHPS survey instrument. It is going to be a little bit shorter. Shorter is always welcome, right, kim?
Speaker 1:Absolutely, if you're on the completion side of the survey, so it would be a little bit shorter. And this is, you know, one of those items that is open for comments in the rule. So actually I was happy to see this. That CMS is, you know, paying attention to monitoring things like the CAHPS survey to make it more user-friendly for patients and families.
Speaker 2:Absolutely, and also another potential welcome change related to the Home Health Quality Reporting Program is the request CMS requesting feedback on the proposal to reduce data submission timeframes from four and a half months to 45 days, which would improve timeliness and actionability of the quality measures and help agencies in a more timely response and implementation of performance improvement projects that they may implement to improve their measures, especially. You know how this and also how this may improve timeliness. Subsequently, timeliness of public reporting of these measures agrees with this potential change or update. Cms is requesting feedback, so please submit that feedback. I know that the timeliness and lag time of data, of data you know and by the time it's submitted and then published in Home Health Compare is often a challenge for organizations?
Speaker 1:Yeah, absolutely it is, but you know it is what it is for now. But I do like this proposal. I think it is going to be helpful on many different levels. We do have one more thing to talk about under measures, kim, and that is the proposal to the regulatory text to the COPs that account for all payer data submission of OASIS data. Can you talk a little bit about that?
Speaker 2:Yes, sure, I mean I think this is again. This is just another update. This is a change to the conditions of participation, both 484.45, reporting OASIS information and 484.55, comprehensive assessment of patients, specifically in response to the change effective July 1st of 2025 to account for all payers' submission of OASIS data. The change is from the word patient to beneficiary because, again, depending on the payer, the individual served may not be referred to as a patient. So this is really a technical update to the COPs.
Speaker 1:Absolutely, and then with any kind of tweak to the regulatory text in the COPs, that will necessitate a review and update to the CHAP home health standards. So we'll be awaiting to see what that final rule looks like so that we can make necessary changes to the CHAP standards, which you know we'll keep everyone in the loop on of how that will roll out. So, Kim, can we switch gears and talk a little bit about the expanded home health value-based purchasing model? There are some changes to the applicable measure set.
Speaker 2:Yep. So I will summarize here Again it's been a little bit of time since I've been heavily involved in home health value-based purchasing, but certainly as it relates to any changes to the applicable measure set and quality, it is an area that we do want to make sure that we address. But providers again are really it's recommended to hear from, get the insight from the National National Alliance for Health Care at Home and and state associations and industry experts who are much more in depth and value based purchasing, because we know that this significantly impacts your reimbursement. But some of the proposed changes include remove as of April 2026, they're proposing to remove the HCAH, home Health CAHPS measures related to care of patients, communication between providers and patients and specific care issues. They're also proposing to reduce the six questions on medications to two questions. And just there is a table in the proposed rule it's table 31, that outlines the current and proposed changes to the Home Health CAHPS survey measures. In addition, they again CMS is seeking public comments on the possibility of initially measuring home health agency performance on future HCAP instruments based on achievement versus achievement and improvement, which is the current process. This also, I believe, will be welcome news for providers under the value-based purchasing model if implemented, because you'll be reimbursed basically solely on that one factor of achievement.
Speaker 2:In addition, cms is proposing the addition of four measures to the applicable measure set. That are, three OASIS-based measures related to bathing and dressing that supplement the discharge function measure, and one claims-based measure, the Medicare Sp per beneficiary for post-acute care setting measure. In addition, cms is proposing to alter the current weights of these individual measures and measure categories in the value-based purchasing model based on these quality reporting changes. So the quality reporting changes don't stand alone right, especially as it relates to home health, because it has a direct impact on not only public reporting but on reimbursement through value-based purchasing. So all of these proposed changes are worth reviewing, analyzing the potential impact on your own organization and operations and then preparing and submitting comments, either individually or through the state or national associations. Jennifer, when I'm looking at the rule, as we're looking at the aspects of home health, are there any requests for information in this rule that providers should be aware of?
Speaker 1:Yeah, kim, there actually are. There were several requests for information or RFIs. The first one was really centered around measure concepts that are under consideration for the future of home health. Cms has really been focused on interoperability for the last couple of years, which means that how can use and you probably need to talk to your IT people if you're planning on making comments for this particular item. The next two, wellness and nutrition, and actually interoperability.
Speaker 1:We have seen those three measure concepts included in the home health proposed rule that did come out a few months ago, so it looks like CMS is duplicating some of these RFIs for each rule that they're putting out the door. Again, wellness and nutrition they want your feedback about specific questions that are seated under both of those topics. Another item is the Respecified Falls with Major Injury measure, as well as two possible changes to the HHCAHPS survey-based measure scoring rules and applicable measure set as they relate to the expanded HHVBP model. So that whole measure concept pretty big area open for comment, and I would strongly encourage you to take a look at that as a provider and give them the feedback, because if you don't give them the feedback, they just make assumptions based on information and data that they have. So we need to give them all of the information and data from your perspective as a provider out there doing it every day, so that they have that perspective.
Speaker 2:I just want to say that this in particular I just want to circle back to the falls at major injury claims-based measure that you talked about, because this is one that organization home health agencies really need to scrutinize and, you know, consider submission of comments, because understand that this is a cross-setting measure currently, which means that it is a measure that is measured right across all the different provider settings that CMS certifies. And this is a concern because it appears as though the change that's proposed is seeking to further align this measure with the other provider settings, and this includes unwitnessed falls, which might work in a 24-hour care setting but not necessarily for home health. So, again, this deserves more scrutiny and consideration of submission and comments and this is why, as much as it's a 591-page rule, you know, subtracting DME, if you're not a DME provider, this absolutely must be reviewed and really evaluate what the potential impact is on your own organization.
Speaker 1:Yeah, I couldn't agree more, and we know that from CMS's past statements they are looking to find particular measures that can be applied across the continuum, the Medicare continuum. So thanks for pointing that out, for sure.
Speaker 2:Yeah, and not just applied, but potentially reported, you know in the future. So, and this is where you know it really becomes, you know, important to make sure that the data is being appropriately gathered and representative of the home health service locations and providers and the care that is provided, the type of care by these providers. Hey, jennifer, so what happens now that the proposed rule is posted?
Speaker 1:that the proposed rule is posted. So what will happen now is we are in an open comment period, which means that anybody it doesn't matter who you are can weigh in and submit comments to CMS based on the content of the proposed changes. And, as I mentioned before, the comment period closes on August 29th and we would expect CMS to then take that time to review all of the comments received. Do their analysis make any tweaks they think they will or will not make? And we would expect to see a final rule come out end of October, early November, and, as CHAP has done in past years, once that final rule posts, we will prepare a summary based on the outcomes of that final rule. We talked a lot about commenting, Kim, here today, so what you know beyond commenting, what do you think providers should be doing with all of this content?
Speaker 2:Well, I think, first and foremost, providers do need to read the rule, the proposed rule, even though it is very, very long, and listen to webinars from industry experts, from the national and state associations, to really be able to condense and understand what some of these hot topic areas are.
Speaker 2:But also, for those areas again, go in and see what the language is and ask any questions again of the, particularly your state and national associations, of any specific areas that are unclear because they are your primary advocates, your own operations and impact or potential impact that these changes would make in terms of impact to your agency, should they be finalized. Again, this is a proposed rule, so there will likely be some changes associated, you know, between the proposed and the final, but you do want to be able to identify what those potential areas of concern are to, or areas of, you know, improvement, if you will, in terms of agency operations, that you want to be able to submit those comments Because, as you said, jennifer, you know CMS looks for comments, both in the positive and in the you know the negative or the concerns, you know, because they do publish them all and they do, you know, respond to each of those comments, but if there are no comments. They proceed with the information that they have.
Speaker 1:Absolutely. And just a tip if you're going to go ahead and submit comments and there's something that you don't like and you want to highlight that out in your letter, it's really great to include with. We don't support it with. Here's some alternatives as some content to include with items that you're not fully on board with Absolutely Any final thoughts.
Speaker 2:That takes us both back to our state and national association days.
Speaker 1:Yes, Identify a solution, always identify a solution, absolutely. Any final thoughts, kim, as we get to the end of our chat cast today?
Speaker 2:You know, I just think I think we've covered it. We've covered a lot and you know we certainly understand that providers, you know, need to be able to really fully assimilate this and these potential changes. As an organization, we are here to support you from a you know, especially as it relates to areas that are regulatory, and also certainly any questions that you have related to the COP's changes or other areas that we can support you with, and I do know that we will have, you know, updates, we'll have webinars and additional information ourselves. But, again, I would recommend, you know, gaining as much information from different sources as you can to fully understand the impact.
Speaker 1:Couldn't agree more, my friend. Thank you so much. So, as we round up this chap cast, we would absolutely encourage you to submit a comment letter to CMS to give them your thoughts and perspective on some of these proposed regulatory changes and also, please share this episode with your organization and beyond so that we can make sure people understand what is happening, what the timeline looks like and what the future landscape may look like for home health. So, thanks to all of you for taking time out of your day to plug into our CHAPcast From Kim, me and the entire CHAP staff. Keep your quality needle moving forward, be compliant, stay safe and well, and thanks for all you do, thank, you.
