Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies

DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Centers for Medicare & Medicaid Services</SUBAGY> <CFR>42 CFR Parts 405, 414, 424, 455, 484, and 498</CFR> <DEPDOC>[CMS-1828-P]</DEPDOC> <RIN>RIN 0938-AV53</RIN> <SUBJECT>Medicare and Medicaid Programs; Calendar Year 2026 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Proposed rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule proposes permanent and temporary behavior adjustments and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. Lastly, this proposed rule proposes policy changes to the face-to-face encounter policy. It also proposes changes to the Home Health Quality Reporting Program (HH QRP) and the expanded Health Value-Based Purchasing (HHVBP) Model requirements. In addition, it would update the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). Lastly it proposes: a technical change to the HH conditions of participation; updates to DMEPOS supplier conditions of payment; updates to provider and supplier enrollment requirements; and changes to DMEPOS accreditation requirements. </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> To be assured consideration, comments must be received at one of the addresses provided in the <E T="02">ADDRESSES</E> section, no later than 5 p.m. EDT on September 2, 2025. </EFFDATE> <HD SOURCE="HED">ADDRESSES:</HD> In commenting, please refer to file code CMS-1828-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed): 1. <E T="03">Electronically.</E> You may (and we encourage you to) submit electronic comments on this regulation to <E T="03">https://www.regulations.gov</E> . Follow the instructions under the “submit a comment” tab. 2. <E T="03">By regular mail.</E> You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1828-P, P.O. Box 8013, Baltimore, MD 21244-8013. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. <E T="03">By express or overnight mail.</E> You may send written comments via express or overnight mail to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1828-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, we refer readers to the beginning of the <E T="02">SUPPLEMENTARY INFORMATION</E> section. <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> For general information about the Home Health Prospective Payment System (HH PPS), send your inquiry via email to <E T="03">HomeHealthPolicy@cms.hhs.gov</E> . For information about the Home Health Quality Reporting Program (HH QRP), send your inquiry via email to <E T="03">HHQRPquestions@cms.hhs.gov</E> . For more information about the expanded Home Health Value-Based Purchasing Model, please visit the Expanded HHVBP Model web page at <E T="03">https://www.cms.gov/priorities/innovation/innovation-models/expanded-home-health-value-based-purchasing-model</E> or send your inquiry via email to <E T="03">HHVBPquestions@cms.hhs.gov</E> . Frank Whelan (410) 786-1302, for Medicare provider and supplier enrollment and DMEPOS accreditation inquiries. Katie Parker (410) 786-0537, Emily Calvert (410) 786-4277, or Jessica Martindale (410) 786-1558 for DMEPOS Prior Authorization inquiries. Alexander Ullman at (410) 786-9671 or <E T="03">DMEPOS@cms.hhs.gov</E> , for DMEPOS Competitive Bidding Program inquiries. For information about the Home Health Conditions of Participation, send your inquiry via email to <E T="03">healthandsafetyinquiries@cms.hhs.gov.</E> </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <E T="03">Inspection of Public Comments:</E> All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following website as soon as possible after they have been received: <E T="03">https://www.regulations.gov/</E> . Follow the search instructions on that website to view public comments. <E T="03">Plain Language Summary:</E> In accordance with 5 U.S.C. 553(b)(4), a plain language summary of this rule may be found at <E T="03">https://www.regulations.gov/</E> . <E T="03">Deregulation Request for Information (RFI):</E> On January 31, 2025, President Trump issued Executive Order (E.O.) 14192 “Unleashing Prosperity Through Deregulation,” which states the Administration policy to significantly reduce the private expenditures required to comply with Federal regulations to secure America's economic prosperity and national security and the highest possible quality of life for each citizen. We would like public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries, and other stakeholders participating in the Medicare program. CMS has made available a Request for Information (RFI) at: ( <E T="03">https://www.cms.gov/medicare-regulatory-relief-rfi</E> ). Please submit all comments in response to this request for information through the provided weblink. <HD SOURCE="HD1">Table of Contents</HD> <EXTRACT> <FP SOURCE="FP-2">I. Executive Summary</FP> <FP SOURCE="FP1-2">A. Purpose and Legal Authority</FP> <FP SOURCE="FP1-2">B. Summary of the Provisions of This Proposed Rule</FP> <FP SOURCE="FP1-2">C. Summary of the Regulatory Impact Analysis</FP> <FP SOURCE="FP-2">II. Home Health Prospective Payment System</FP> <FP SOURCE="FP1-2">A. Overview of the Home Health Prospective Payment System</FP> <FP SOURCE="FP1-2">B. Monitoring the Effects of the Implementation of the PDGM</FP> <FP SOURCE="FP1-2">C. Proposed CY 2026 Payment Adjustments Under the HH PPS</FP> <FP SOURCE="FP1-2">D. Proposed CY 2026 Home Health Low Utilization Payment Adjustment (LUPA) Thresholds, Functional Impairment Levels, Comorbidity Sub-Groups, and Case-Mix Weights</FP> <FP SOURCE="FP1-2">E. Proposed CY 2026 Home Health Payment Rate Updates</FP> <FP SOURCE="FP1-2"> F. Proposed Regulation Change to Face-to-Face Encounter </FP> <FP SOURCE="FP-2">III. Home Health Quality Reporting Program (HH QRP)</FP> <FP SOURCE="FP1-2">A. Background and Statutory Authority</FP> <FP SOURCE="FP1-2">B. Summary of the Provisions of This Proposed Rule</FP> <FP SOURCE="FP1-2">C. Quality Measures Currently Adopted for the CY 2026 HH QRP</FP> <FP SOURCE="FP1-2">D. Proposed Removal of the COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date (Patient/Resident COVID-19 Vaccine) Measure Beginning With the CY 2026 HH QRP</FP> <FP SOURCE="FP1-2">E. Proposed Removal of Four Standardized Patient Assessment Data Elements Beginning With the CY 2027 HH QRP</FP> <FP SOURCE="FP1-2">F. Amending the Data Non-Compliance Reconsideration Request Policy and Process Beginning With the FY 2027 HH QRP</FP> <FP SOURCE="FP1-2">G. Updates to Requirements for OASIS All-Payer Data Submission</FP> <FP SOURCE="FP1-2">H. Proposed HHCAHPS Survey Updates</FP> <FP SOURCE="FP1-2">I. HH QRP Quality Measure Concepts Under Consideration for Future Years—Request for Information</FP> <FP SOURCE="FP1-2">J. Potential Revision of the Final Data Submission Deadline Period From 4.5 Months to 45 Days—Request for Information (RFI)</FP> <FP SOURCE="FP1-2">K. Advancing Digital Quality Measurement in the HH QRP—Request for Information</FP> <FP SOURCE="FP1-2">L. Form, Manner, and Timing of Data Submission Under the HH QRP</FP> <FP SOURCE="FP1-2">M. Policies Regarding Public Display of Measure Data for the HH QRP</FP> <FP SOURCE="FP-2">IV. The Expanded Home Health Value-Based Purchasing (HHVBP) Model</FP> <FP SOURCE="FP1-2">A. Background</FP> <FP SOURCE="FP1-2">B. Proposed Changes to HHVBP Measure Removal Factors</FP> <FP SOURCE="FP1-2">C. Proposed Changes to the Expanded HHVBP Model's Applicable Measure Set</FP> <FP SOURCE="FP1-2">D. HHVBP Quality Measure Concepts Under Consideration for Future Years—Request for Information</FP> <FP SOURCE="FP-2">V. Updates to the Home Health Agency CoPs To Align With the OASIS All-Payer Submission Requirements</FP> <FP SOURCE="FP1-2">A. Statutory Authority and Background</FP> <FP SOURCE="FP1-2">B. Updates to the Home Health Agency CoPs To Align With the OASIS All-Payer Submission Requirements (§§ 484.45(a) and 484.55(d)(1)(i))</FP> <FP SOURCE="FP-2">VI. Provider Enrollment, Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation Policies, and DMEPOS Prior Authorization</FP> <FP SOURCE="FP1-2">A. Provider Enrollment</FP> <FP SOURCE="FP1-2">B. DMEPOS Supp ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 1114k characters. 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