HCANYS Submits Comments on CMS’s CY 2026 Home Health Proposed Rule

The Situation Report | September 2, 2025

HCANYS Vice President for Finance and Management Patrick Conole submitted comments yesterday to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposed Calendar Year (CY) 2026 payment rule for home health. HCANYS members can download those comments here.

The proposed rule puts the stability of home health care at risk due to CMS proposing the application of a fatally flawed budget neutrality methodology for assessing whether the Patient Driven Groupings Model (PDGM) payment model led to budget neutral spending in years 2020 through 2024.  

Now, based on the PDGM experiences in 2020 through 2024, CMS is proposing a -4.059% budget neutrality permanent adjustment to account for the one-half of the remaining adjustment from CY 2025 (-1.975%) plus the additional 2024 data year adjustment of -2.087% as well as an additional -5% budget neutrality temporary payment adjustment to recoup approximately $786 million of the $5.3 billion in alleged overpayments from 2020-2024. 

In our comments, HCANYS urges CMS to not finalize the proposed permanent and temporary adjustments in the proposed rule and implores CMS to refine its methodologies to make them consistent with Congressional intent. CMS’ methodology contains critical flaws that overstate the permanent and temporary payment adjustments, incorrectly attributing them to provider behavior, when they are largely the result of unrelated policy changes and technical errors. 

HCANYS' comments on the proposed rule also highlight the inadequacy of the 2.4 percent market basket update, express our serious concerns about the home health wage index and its impact of agencies in New York, and provide positive comments on CMS’ proposal to change who may conduct the face-to-face (F2F) encounter. In our comments, HCANYS also asks CMS to limit the frequency the Outcome and Assessment Information Set (OASIS) is modified, which increases resource use for agencies in terms of staff training, coordination with vendors, and altered productivity associated with the learning curve required for collecting new material. Lastly, HCANYS provided comments on CMS’ proposals involving a new Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey beginning April 2026 and updates to the Home Health Value Based Purchasing Program (HHVBP) and Medicare provider enrollment revisions. 

CMS is expected to finalize the rule, following the comment period, in late October, with the rule going into effect on January 1, 2026.