The headline was a 1.3% net payment cut for home health in 2026, down from the proposed 6.4% reduction. Agencies breathed a sigh of relief. But the cut itself is only part of the story.
CMS also recalibrated PDGM case-mix weights, updated LUPA thresholds, expanded OASIS to all-payer patients, and overhauled HHVBP scoring. For agencies that don't adjust their workflows and visit patterns, the real financial impact will be larger than the headline number suggests.
The CY 2026 Home Health Prospective Payment System Final Rule (CMS-1828-F) was finalized November 28, 2025, effective January 1, 2026.
The net payment change: -1.3%. The breakdown:
For context: CMS has applied permanent behavior adjustments each year since PDGM launched in 2020. The 2026 adjustment is the last year this temporary/permanent split applies, which changes the math going forward.
This isn't a structural change to how PDGM works. It's a recalculation of the relative payment values assigned to each clinical grouping based on updated cost data.
What it means for your agency: Depending on your patient mix, some groupings will pay more and some will pay less than they did in 2025. Agencies with heavy wound care, neurological, or behavioral health caseloads should model the 2026 weights against their current patient census.
If your OASIS documentation isn't accurately capturing clinical complexity and comorbidities, you're likely getting underpaid under the new weights.
CMS updated LUPA thresholds for 2026. Several clinical groupings now require one additional visit to clear the threshold and receive the full episode payment.
This is a direct operational risk. The difference between a full PDGM episode payment and a per-visit LUPA rate is often $500 to $1,500 per period. Your clinical and scheduling teams need to know which groupings changed.
If your agency is still treating OASIS as Medicare-only documentation, that is a compliance gap. Effective July 1, 2025, OASIS data collection and submission became required for all skilled patients regardless of payer source.
For larger-volume agencies, the new HHVBP scorecard weights are: 40% OASIS-based outcome measures, 40% claims-based measures, 20% HHCAHPS (revised survey launching April 2026).
Three new functional measures were added: Improvement in Bathing (M1830), Improvement in Upper-Body Dressing (M1810), and Improvement in Lower-Body Dressing (M1820). The Medicare Spending per Beneficiary (MSPB-PAC) measure was also added at 10%.
The HHCAHPS-based measures that previously anchored the scorecard have been removed. Agencies that built their HHVBP strategy around patient survey scores need to shift focus toward functional improvement documentation.
CMS broadened which practitioners can perform the face-to-face encounter. The practitioner performing the F2F no longer needs to be the certifying physician. Update your intake and referral workflows to reflect this.
WorldView helps home health agencies track physician orders, documentation completeness, and visit-level workflows in real time. It's the operational layer that protects PDGM payments and HHVBP scores. Schedule a demo to see how it fits with your EMR.