{"id":324354,"date":"2025-11-30T06:40:22","date_gmt":"2025-11-30T06:40:22","guid":{"rendered":"https:\/\/peraltafinancing.com\/uncategorized\/cms-finalizes-2026-home-health-medicare-payment-rule-with-1-3-aggregate-reduction\/"},"modified":"2025-11-30T06:40:22","modified_gmt":"2025-11-30T06:40:22","slug":"cms-finalizes-2026-home-health-medicare-payment-rule-with-1-3-aggregate-reduction","status":"publish","type":"post","link":"https:\/\/fivemor.com\/?p=324354","title":{"rendered":"CMS Finalizes 2026 Home Health Medicare Payment Rule With 1.3% Aggregate Reduction"},"content":{"rendered":"


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The U.S. Centers for Medicare & Medicaid Services (CMS) released its delayed and much-anticipated CY 2026 home health final payment rule on Friday, Nov. 28. <\/p>\n

CMS estimates that the final rule will decrease aggregate Medicare payments to home health agencies by 1.3%, or $220 million, compared to calendar year 2025.<\/p>\n

This is well below the 6.4% aggregate reduction CMS proposed<\/a> in June. The changes in the final rule mean that home health providers will see about approximately $915 million more in payments next year, the National Alliance for Care at Home noted. While the Alliance commended CMS for making these changes, the organization emphasized that the final rule still represents a payment cut that will hurt providers and patients.<\/p>\n

\u201cWhile the Alliance acknowledges that CMS took into account some of the home health community\u2019s recommended changes in its final rule, resulting in a lower payment cut for next year, a 1.3% overall reduction in payments compared to 2025 will likely result in continued reductions in patient access, the closure of more home health agencies, and more patients waiting in costly hospital settings instead of recovering safely at home,\u201d said Dr. Steve Landers, CEO for the Alliance.<\/p>\n

The final rule includes an estimated 2.4% rate increase, offset by an estimated final permanent adjustment of 0.9% and a final temporary adjustment that will lower payments by 2.7%. The rule also contains an estimated 0.1% decrease related to an updated fixed-dollar loss (FDL) ratio for outlier payments. <\/p>\n

As for the permanent and temporary adjustments related to Patient-Driven Groupings Model (PDGM)-related behavior changes, the rule finalizes a permanent -1.023% adjustment.<\/p>\n

\u201cFor this final rule we modified the permanent adjustment from our proposal after commenters raised concerns that behavior change after CY 2022 might be attributable to factors unrelated to the implementation of the PDGM, such as the introduction of the OASIS-E assessment; expansion of home health value-based purchasing; and increased Medicare Advantage penetration,\u201d CMS\u2019 fact sheet stated. <\/p>\n

CMS also is finalizing a -3.0% temporary adjustment to be applied to the 2026 payment rate. This level of adjustment is meant to \u201cmitigate a significant single year payment reduction, financial instability and potential access to care issues,\u201d according to the fact sheet.<\/p>\n

The proposed rule had included provisions that amounted to a 9% reduction in the 30-day base payment rate \u2013 the largest cut ever proposed.<\/p>\n

The rule marks the fourth straight year of permanent cuts to home health Medicare payments. In 2024, CMS\u2019 final home health rule included a net aggregate payment increase of 0.5% \u2013 but the baseline cuts amounted<\/a> to a -1.975% permanent projected adjustment. <\/p>\n

CMS\u2019 announcement was dramatically delayed compared to years past. Typically, the rule is issued at the end of October or early November, but a record 43-day government shutdown<\/a> significantly delayed its issuance. <\/p>\n

Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services, described the rule as \u201can improvement over past actions.\u201d<\/p>\n

\u201cTo meet [rising] demand, payment support is critical,\u201d Sloan said in a statement. \u201cThe final rule, released today, demonstrates some recognition by CMS of this reality. In a marked contrast to Medicare fee-for-service payment rate decisions made since CY2023 \u2013 which had resulted in nearly 9% in cuts \u2013 CMS today finalized a payment reduction of 1.3%, which includes a -1.023 percent permanent adjustment and the -3.0 percent temporary adjustment.\u201d<\/p>\n

The full fact sheet on the final rule can be viewed here<\/a>.<\/p>\n

Other final changes <\/strong><\/h3>\n

CMS finalized several other changes in its final rule, including factors beyond payment rates. <\/p>\n

The proposed rule included changes to the face-to-face encounter policy that would allow physicians to perform face-to-face encounters regardless of whether the physician is the certifying practitioner or whether they cared for the patient in the facility from which the patient was referred. The final rule solidified this change. <\/p>\n

Also included in the final rule were modifications to the home health value-based purchasing (HHVBP) model, updated low-utilization payment adjustment (LUPA) thresholds, and a recalibration of PDGM case weights. <\/p>\n

Additionally, the final rule includes elements focused on rooting out fraud, waste and abuse, including creating several new Medicare provider enrollment provisions and revising others. <\/p>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"

The U.S. Centers for Medicare & Medicaid Services (CMS) released its delayed and much-anticipated CY 2026 home health final payment rule on Friday, Nov. 28. CMS estimates that the final rule will decrease aggregate Medicare payments to home health agencies by 1.3%, or $220 million, compared to calendar year 2025. This is well below the […]<\/p>\n","protected":false},"author":1,"featured_media":298684,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[108448,99155],"tags":[35706,29171,11308,597,1159,11652,11160,36225,7318],"dealstore":[],"offerexpiration":[],"class_list":["post-324354","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cms","category-medicare","tag-aggregate","tag-cms","tag-finalizes","tag-health","tag-home","tag-medicare","tag-payment","tag-reduction","tag-rule"],"yoast_head":"\nCMS Finalizes 2026 Home Health Medicare Payment Rule With 1.3% Aggregate Reduction - Som2ny Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fivemor.com\/?p=324354\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS Finalizes 2026 Home Health Medicare Payment Rule With 1.3% Aggregate Reduction - Som2ny Network\" \/>\n<meta property=\"og:description\" content=\"The U.S. Centers for Medicare & Medicaid Services (CMS) released its delayed and much-anticipated CY 2026 home health final payment rule on Friday, Nov. 28. 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