A major shift occurred for home health agencies in 2026 when CMS updated the Home Health Value-Based Purchasing (HHVBP) Model again, as it has every year since the national expansion. These changes affect the measure set, scoring methodology, and payment adjustments tied to provider performance. The HHVBP Model can be a valuable tool to improve payment for high performers, or it can add further burden to payment cuts for providers that are outperformed by the top half of their cohort. Results from the 2026 HHVBP performance year will be applied to 2028 payments, but focus is needed now to help ensure that providers’ performance will have a positive future payment impact, particularly as the home health industry continues to face potential payment reductions.
1. Key Changes to the HHVBP Model Measure Set for 2026
The 2026 HHVBP Model measures and weightings have changed in all three categories, including OASIS-based measures, claim-based measures, and Consumer Assessment of Healthcare Providers and Systems (CAHPS)-based measures.
CMS has added three OASIS-based measures to complement the Discharge Function Score (DC Function) measure, giving a more complete picture of the patient’s ability to care for themselves. Added are OASIS items M1830 improvement in bathing, M1810 improvement in upper body dressing, and M1820 improvement in lower body dressing, with a total weighting of 7% for the larger-volume cohort and 9% for the smaller-volume cohort. The three measures that remain from the 2025 HHVBP are improvement in dyspnea, improvement in management of oral medications, and DC Function. The overall weighting for the OASIS measures is 40% for the larger-volume cohort and 50% for the smaller-volume cohort. It is important that providers monitor and measure their OASIS-based performance and have an efficient and effective process in place to evaluate on a patient-by-patient basis.
Claim-based measures have been revised in 2026 with the addition of Medicare Spending Per Beneficiary – Post Acute Care (MSPB-PAC), which is a new measure for HHVBP purposes but has been used as a publicly reported measure since 2017. While this data has been available for some time, this is the first time it has been utilized in a way that has a potential payment impact. This measure puts providers on the hook for additional related care claims while the patient is admitted for a home health treatment period of 60 days and for an additional 30 days post the treatment period for a total of 90 days. The MSPB-PAC is weighted at 10% for the larger-volume cohort and 12.5% for the smaller-volume cohort group. The Potentially Preventable Hospitalization (PPH) and Discharge to Community – Post-Acute Care Measure (DTC-PAC) remain in the claim-based measure group, carrying over from 2025, but have shifted weighting to be equal for each at 15% for the larger-volume cohort and 18.75% for the smaller-volume cohort. With two measures having post-discharge claims impact, it is now more important than ever that providers focus efforts on successful discharge planning to meet the patient’s needs. The claim-based measures’ overall weighting in HHVBP is 40% for the larger-volume cohort and 50% for the smaller-volume cohort.
CMS is removing three of the five Home Health Care CAHPS (HHCAHPS)-related measures in 2026, including Care of Patients/Professional Care, Communication Between Providers and Patients, and Team Discussion Regarding Care. The 2026 measures now include only Overall Rating of Home Health Care and Willingness to Recommend, so these will continue to be a needed area of focus, but only for the larger-volume cohort for which these measures will be weighted at 10% each, with a total of 20% for the CAHPS-based measure category.
2. How 2026 Performance Payment Adjustments Will Be Applied in 2028
In August 2026, CMS will release the Annual Performance Reports (APRs), which will provide the CMS data-determined HHVBP payment percentage to be applied to all 2028 Medicare home health claims. Until then, providers should review their Interim Payment Reports (IPRs), which CMS issues quarterly, in order to evaluate the reports for accuracy. If there is a calculation issue, it is incumbent on the provider to notify CMS of the error and request recalculation within the timelines allowed.
3. CMS Emphasis for 2026: Quality, Outcomes, & Patient Experience
The updated 2026 HHVBP Model continues to reward providers that demonstrate improved clinical outcomes, prevention of potentially preventable hospitalizations, and successful care planning and coordination during care treatment periods and after home health discharge. Patient experience scores with high overall ratings and willingness to recommend are still valued, so providers need to continue to focus on these measures, as these scores reflect the patient’s voice.
4. What Should Home Health Agencies Do Now?
- Understand your current performance with the 2026 HHVBP measures.
- Determine which measures need to be improved and develop a plan to support the measurement and management of all the HHVBP measures.
- Strengthen communication, responsiveness, and patient engagement strategies.
- Focus on high-impact clinical outcomes such as functional improvement, medication management, and dyspnea.
- Find a “real time” tool to help manage your HHVBP performance. The CMS IPRs and APRs are critical, but are available too late to proactively manage the measures.
5. What Is the Bottom Line for 2026?
Start now if you haven’t! The 2026 HHVBP Model measures are already in place with data collection underway beginning January 1, 2026. Providers that proactively adjust their HHVBP strategies now and throughout the performance year based on their data will be better positioned to help increase their 2028 payment adjustments and remain competitive in a value-driven home health environment. If you need assistance developing strategies to monitor and manage your HHVBP Model performance, contact a professional at Forvis Mazars.