The Centers for Medicare & Medicaid Services (CMS) recently released the CY 2026 Home Health proposed rule on June 30, 2025, introducing some major changes that Home Health Agencies (HHAs) are now reviewing and preparing to comment on. This rule proposes the largest payment cut since the Home Health Agency Prospective Payment System (HHA PPS) began in CY 2000. CMS is suggesting a reimbursement cut of 6.4%, or $1.135 billion.

Big changes are coming to the way nursing homes are rated, and if you're part of the industry, it’s vital to prepare now. Starting in July 2025, the Centers for Medicare & Medicaid Services (CMS) is implementing updates to the Five-Star Quality Rating System to make ratings more accurate, transparent, and reflective of current performance. These changes are detailed in the QSO-25-20-NH memorandum, marking a significant shift for skilled nursing facilities (SNFs) across the country. Beyond understanding these updates, facilities must adapt quickly to maintain and improve their ratings—and that’s where Strategic Healthcare Programs (SHP) can help.

On July 1st, 2023 CMS began requiring home health agencies to document their utilization of telehealth services on their Medicare Fee-For-Service (FFS) claims. As finalized in the CY 2023 Home Health Payment System Rate Update, agencies are responsible to identify one of three services they provide using new Healthcare Common Procedure Coding System (HCPCS) codes. These codes are added as a separate visit line on the claim based on the date each service is provided. CMS notes in the rule that these services are for reporting only, since CMS does not reimburse for these services. The HCPCS codes are:

CMS shared the details of the new Hospice Special Focus Program (SFP) in the CMS Home Health Prospective Payment System Proposed Rule posted in the Federal Register on July 10th. While expected, CMS often adds rule-making for non-home health services when either timing or urgency makes it necessary. Based on the scrutiny Hospice has been under from numerous OIG reports and the negative publicity from articles written by ProPublica and the New Yorker, Hospice has been in the crosshairs of increased oversight.