July 15, 2025 • 31 mins
A massive regulatory overhaul looms on the horizon for home health agencies. The proposed Calendar Year 2026 Home Health Payment Update rule spans nearly 600 pages, packed with changes that extend far beyond payment adjustments.
- Proposed expansion of face-to-face encounter policy to allow not just physicians but also NPs, CNSs, and PAs to perform encounters regardless of prior patient relationship
- CMS plans to remove COVID-19 vaccine reporting measure and four social determinants of health assessment items from OASIS data collection
- Proposed shorter HHCAHPS survey implementation beginning April 2026 with fewer questions
- Potential reduction in data submission timeframes from 4.5 months to 45 days to improve measure timeliness
- Updates to Home Health Value-Based Purchasing including measurement changes and reweighting of components
- Technical updates to Conditions of Participation text to accommodate all-payer OASIS data submission
- Multiple requests for information on interoperability, wellness measures, and falls reporting
Comments on these proposed changes must be submitted to CMS by August 29th. The final rule is expected to be published in late October or early November.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Greetings.
I'm Jennifer Kennedy, the leadfor compliance and quality at
CHAP, and welcome to CHAPcast.
Today we're going to be talkingabout the calendar year 2026
home health payment update ruleand I shortened that title
significantly because it is along title for the rule.
(00:21):
But today we're going to justfocus on the home health
provisions in this 591 of a rule, and I'm really so very happy
(01:05):
to be talking about the homehealth provisions with my
colleague and good friend, kimSkian, who is our vice president
for accreditation.
So, kim, wow, big rule.
Speaker 2 (01:21):
That's right and we've read plenty of them, right
, Jennifer?
Speaker 1 (01:26):
Yeah, more than I can count.
I think, and I think you know,for our purposes of doing what
we do and serving our partnersout in the CHAP community, is
dividing this rule into just thehome health provisions and then
dealing with all of the DMEprovisions separately I think
(01:51):
helps, or will help, providersget their head around what CMS
has included in this rule.
And you know, just to be honest, I'm sure providers are feeling
overwhelmed just looking atthis huge document, but it was
overwhelming to read it for sure.
Speaker 2 (02:13):
Absolutely, and the only other thing I would add is
that our focus is on theproposed regulatory and quality
reporting changes.
We will leave the financialanalysis related to payment
updates and PDGM changes toindustry experts, such as the
National Alliance for Healthcareat Home State Association and,
(02:36):
again, industry consulting firmsand experts, Just to provide
further detail, because thereare many changes associated with
the financial impact as wellthat providers do need to ensure
that they understand and reviewand understand the impact for
their agencies.
Speaker 1 (02:57):
Yeah, I can't agree with you more.
You know, we know that in thisproposed rule there's a 6.4%
permanent deduction, or adecrease in the rate for home
health providers proposed forcalendar year or fiscal year
2026.
(03:17):
So that I mean it issignificant and I think you're
spot on with providers lookingto national organizations as
they unpack this rule and lookat all of the financial
parameters that are included andthat will have a significant
impact on home health providersin the space.
(03:39):
We, as you said, kim, you knowthat's really not our scope here
at CHAP, but it doesn't meanit's not important, for sure,
absolutely.
So let's talk about the thingsthat are in our scope and that
you know.
We need to make sure providersunderstand what CMS is proposing
(04:00):
.
And the first thing I'd like tothrow out there is the proposed
changes to the face-to-faceencounter policy.
Speaker 2 (04:09):
You know, I think that this is one of the positive
proposed changes in the ruleand I believe it will be largely
welcomed by home healthproviders and advocates.
In this change, cms is proposingto change the face-to-face
regulation to allow, you know,the physicians in addition to
(04:32):
physicians, nps, nursepractitioners, cnss, and
physician's assistants or PAs toperform that face-to-face
encounter and certification,regardless of whether they are
the certifying practitioner orwhether they cared for the
patient in the acute orpost-acute facility from which
(04:53):
the patient was directlyadmitted to home health and who
is different from the certifyingprovider.
And this proposed change isgoing to align more closely with
the CARES Act implemented as aresult of COVID, by removing
that limitation on whichphysicians are allowed to
complete the face-to-faceencounter and broadening the
(05:13):
number of practitioners who canperform the face-to-face.
It's important, though, to notethat of the other requirements
of the face-to-face, such as thetiming and content, will not be
changed under this rule andfrom a survey perspective, you
know we don't review for thecomponents or technical
(05:34):
compliance with the face-to-face.
However, we do know this is asignificant compliance and
payment issue that has resultedin agency in recruitment of
funds due to technical denialsidentified during CMS or
contractor audits.
So this is a.
(05:54):
It really is a meaningful ifit's finalized, is a meaningful
change for providers change forproviders.
Speaker 1 (06:10):
I agree with that and I'm glad you said if finalized
because everything that we'retalking about today is in
proposed status.
It means that CMS put it outthere we have a 60-day comment
period, which that is on August29th that comments have to be
submitted to CMS.
So CMS has to read all of thosecomments and weigh them and we
(06:36):
could see changes from thisproposed rule to the final.
So thank you for putting it outthere that if it's finalized we
would march forth as it iswritten here or if they make any
kind of tweaks to it based oncomments, correct?
Speaker 2 (06:56):
Absolutely, and that's why comments are so
important, both in support andalso identifying any concerns.
We want to make sure that, evenif a provider supports the
change, that you go on recordand say that, that in the
comment, that you do supportthat change and again, if you
have other recommendations orconcerns, to be able to
(07:18):
highlight them as well.
So, jennifer, in addition, Iknow we talked about
face-to-face, but there are somesignificant proposed changes to
the quality reporting program.
I guess I wouldn't say changes,more significant tweaks to the
quality reporting program.
Do you want to discuss thatjust a little bit?
Speaker 1 (07:43):
Yeah, yeah, and I'm really happy to you know.
Talk about quality, kim.
As you know, at any time wecould talk all day about quality
.
So CMS, in this rule, isproposing to remove the COVID-19
vaccine percentage of patientswho are up to date with the
measure and then thatcorresponding outcome and
(08:06):
assessment information OASISdata element.
Cms would continue to completethe, if this goes through,
complete the OASIS item throughApril 2026.
But it would seem that CMS isnot finding the need to continue
(08:30):
to have that as a measure.
They're also proposing, kim,removal of four social
determinants of healthassessment items in that
standardized patient data set.
It is inclusive of one livingsituation item, two food items
(08:52):
and one utilities items andwe've been seeing this theme
through rulemaking with thefocus coming off of things like
social determinants of healthand health equity that have been
very much up front in pastyears prior to this
administration.
(09:12):
So, given what theadministration changed and
refocused and retooling, we'reseeing things like social
determinants of health andhealth equity fall out of focus
with CMS.
Now they also are proposingsome other things as it relates
(09:44):
to quality and measures as well.
Providers submit a request forreconsideration of an initial
determination of noncomplianceif they can give evidence and
demonstrate full compliance.
What are your thoughts on that?
Speaker 2 (10:01):
Yeah, this is another area that really what CMS is
doing is codifying intoregulation the process that is
in place, that agencies canrequest a reconsideration for
extraordinary services beyondthe agency's control and that
the reconsideration is submittedwithin 30 days of the notice of
(10:22):
noncompliance.
Jennifer, this is similar towhat we see in hospice as well,
where agencies come to the endof the reporting year and then
they receive the letter thatthey're in non-compliance,
meaning that they're below the90% compliance threshold for
(10:47):
submission of in home healthOASIS assessment submission in
the timeframe, oasis assessmentsubmission in the timeframe or
they have not participated inCAPS or submitted an exemption
and largely the reasons that CMSwill overturn.
And I've had some pastexperience with working with
agencies prior to being withCHAP working with agencies on
(11:12):
these reconsiderations andgenerally when CMS says outside
the agency's control, they don'tmean situations where there was
a change in staff or staffwasn't available or the OASIS
error summary reports were notchecked and fatal errors were
not addressed, or if there's atechnology you know concern, or
(11:36):
if an organization is changingEMRs, typically they're looking
at external factors such asweather-related or, you know,
event-related situations thatwould have prohibited this
submission, so there may be someadditional leeway they're going
to define, hopefully, incodifying this regulation, as
(12:00):
far as extraordinarycircumstances, but providers
just need to be aware that,historically, the extraordinary
circumstances are beyond whatwould have been beyond the
agency's control.
Speaker 1 (12:14):
Yeah, you know what.
I'm really glad that theydefine that, you know, because
not all the time you're going tohave a federal declaration of
an emergency event.
It may just happen at the statelevel, but it still interrupts
and impacts operations, right?
So that would be a perfectexample to provide evidence that
you had this event in yourstate, in your area, and you're
(12:39):
requesting that reconsideration.
Speaker 2 (12:43):
And I would just say proactively and currently,
organizations should beregularly reviewing their OASIS
submission reports and the errorsummary to ensure that any
fatal errors are addressed, tobe able to be resubmitted so
that the organization doesremain in compliance.
Speaker 1 (13:05):
Yeah, couldn't agree more.
So also, another inclusion isthat CMS is proposing
implementing a revised HHCAHPSsurvey and they're targeting
that beginning with April 2026sample month.
So when we look at this, it isproposing to remove several
(13:31):
items that they include in themulti-item specific care issues
measure, and three of thoseitems used in the specific care
issues measure would remain inthe HHCAHPS survey instrument.
It is going to be a little bitshorter.
Shorter is always welcome,right, kim?
(13:52):
Absolutely, if you're on thecompletion side of the survey,
so it would be a little bitshorter.
And this is, you know, one ofthose items that is open for
comments in the rule.
So actually I was happy to seethis.
That CMS is, you know, payingattention to monitoring things
(14:14):
like the CAHPS survey to make itmore user-friendly for patients
and families.
Speaker 2 (14:21):
Absolutely, and also another potential welcome change
related to the Home HealthQuality Reporting Program is the
request CMS requesting feedbackon the proposal to reduce data
submission timeframes from fourand a half months to 45 days,
which would improve timelinessand actionability of the quality
(14:45):
measures and help agencies in amore timely response and
implementation of performanceimprovement projects that they
may implement to improve theirmeasures, especially.
You know how this and also howthis may improve timeliness.
Subsequently, timeliness ofpublic reporting of these
(15:05):
measures agrees with thispotential change or update.
Cms is requesting feedback, soplease submit that feedback.
I know that the timeliness andlag time of data, of data you
(15:37):
know and by the time it'ssubmitted and then published in
Home Health Compare is often achallenge for organizations?
Speaker 1 (15:41):
Yeah, absolutely it is, but you know it is what it
is for now.
But I do like this proposal.
I think it is going to behelpful on many different levels
.
We do have one more thing totalk about under measures, kim,
and that is the proposal to theregulatory text to the COPs that
(16:06):
account for all payer datasubmission of OASIS data.
Can you talk a little bit aboutthat?
Speaker 2 (16:12):
Yes, sure, I mean I think this is again.
This is just another update.
This is a change to theconditions of participation,
both 484.45, reporting OASISinformation and 484.55,
comprehensive assessment ofpatients, specifically in
response to the change effectiveJuly 1st of 2025 to account for
(16:36):
all payers' submission of OASISdata.
The change is from the wordpatient to beneficiary because,
again, depending on the payer,the individual served may not be
referred to as a patient.
So this is really a technicalupdate to the COPs.
Speaker 1 (17:03):
Absolutely, and then with any kind of tweak to the
regulatory text in the COPs,that will necessitate a review
and update to the CHAP homehealth standards.
So we'll be awaiting to seewhat that final rule looks like
so that we can make necessarychanges to the CHAP standards,
(17:26):
which you know we'll keepeveryone in the loop on of how
that will roll out.
So, Kim, can we switch gearsand talk a little bit about the
expanded home health value-basedpurchasing model?
There are some changes to theapplicable measure set.
Speaker 2 (17:45):
Yep.
So I will summarize here Againit's been a little bit of time
since I've been heavily involvedin home health value-based
purchasing, but certainly as itrelates to any changes to the
applicable measure set andquality, it is an area that we
(18:05):
do want to make sure that weaddress.
But providers again are reallyit's recommended to hear from,
(18:35):
get the insight from theNational National Alliance for
Health Care at Home and andstate associations and industry
experts who are much more indepth and value based purchasing
, because we know that thissignificantly impacts your
reimbursement.
But some of the proposedchanges include remove as of
April 2026, they're proposing toremove the HCAH, home Health
CAHPS measures related to careof patients, communication
between providers and patientsand specific care issues.
They're also proposing toreduce the six questions on
medications to two questions.
(18:56):
And just there is a table inthe proposed rule it's table 31,
that outlines the current andproposed changes to the Home
Health CAHPS survey measures.
In addition, they again CMS isseeking public comments on the
possibility of initiallymeasuring home health agency
performance on future HCAPinstruments based on achievement
(19:19):
versus achievement andimprovement, which is the
current process.
This also, I believe, will bewelcome news for providers under
the value-based purchasingmodel if implemented, because
you'll be reimbursed basicallysolely on that one factor of
achievement.
In addition, cms is proposingthe addition of four measures to
(19:41):
the applicable measure set.
That are, three OASIS-basedmeasures related to bathing and
dressing that supplement thedischarge function measure, and
one claims-based measure, theMedicare Sp per beneficiary for
post-acute care setting measure.
In addition, cms is proposingto alter the current weights of
these individual measures andmeasure categories in the
(20:02):
value-based purchasing modelbased on these quality reporting
changes.
So the quality reportingchanges don't stand alone right,
especially as it relates tohome health, because it has a
direct impact on not only publicreporting but on reimbursement
through value-based purchasing.
So all of these proposedchanges are worth reviewing,
(20:25):
analyzing the potential impacton your own organization and
operations and then preparingand submitting comments, either
individually or through thestate or national associations.
Jennifer, when I'm looking atthe rule, as we're looking at
the aspects of home health, arethere any requests for
information in this rule thatproviders should be aware of?
Speaker 1 (20:48):
Yeah, kim, there actually are.
There were several requests forinformation or RFIs.
The first one was reallycentered around measure concepts
that are under considerationfor the future of home health.
Cms has really been focused oninteroperability for the last
(21:36):
couple of years, which meansthat how can use and you
probably need to talk to your ITpeople if you're planning on
making comments for thisparticular item.
The next two, wellness andnutrition, and actually
interoperability.
We have seen those three measureconcepts included in the home
health proposed rule that didcome out a few months ago, so it
(21:57):
looks like CMS is duplicatingsome of these RFIs for each rule
that they're putting out thedoor.
Again, wellness and nutritionthey want your feedback about
specific questions that areseated under both of those
topics.
Another item is the RespecifiedFalls with Major Injury measure
(22:21):
, as well as two possiblechanges to the HHCAHPS
survey-based measure scoringrules and applicable measure set
as they relate to the expandedHHVBP model.
So that whole measure conceptpretty big area open for comment
(22:44):
, and I would strongly encourageyou to take a look at that as a
provider and give them thefeedback, because if you don't
give them the feedback, theyjust make assumptions based on
information and data that theyhave.
So we need to give them all ofthe information and data from
your perspective as a providerout there doing it every day, so
(23:08):
that they have that perspective.
Speaker 2 (23:11):
I just want to say that this in particular I just
want to circle back to the fallsat major injury claims-based
measure that you talked about,because this is one that
organization home healthagencies really need to
scrutinize and, you know,consider submission of comments,
(23:33):
because understand that this isa cross-setting measure
currently, which means that itis a measure that is measured
right across all the differentprovider settings that CMS
certifies.
And this is a concern becauseit appears as though the change
(23:54):
that's proposed is seeking tofurther align this measure with
the other provider settings, andthis includes unwitnessed falls
, which might work in a 24-hourcare setting but not necessarily
for home health.
So, again, this deserves morescrutiny and consideration of
submission and comments and thisis why, as much as it's a
(24:16):
591-page rule, you know,subtracting DME, if you're not a
DME provider, this absolutelymust be reviewed and really
evaluate what the potentialimpact is on your own
organization.
Speaker 1 (24:34):
Yeah, I couldn't agree more, and we know that
from CMS's past statements theyare looking to find particular
measures that can be appliedacross the continuum, the
Medicare continuum.
So thanks for pointing that out, for sure.
Speaker 2 (24:50):
Yeah, and not just applied, but potentially
reported, you know in the future.
So, and this is where you knowit really becomes, you know,
important to make sure that thedata is being appropriately
gathered and representative ofthe home health service
(25:12):
locations and providers and thecare that is provided, the type
of care by these providers.
Hey, jennifer, so what happensnow that the proposed rule is
posted?
Speaker 1 (25:24):
that the proposed rule is posted.
So what will happen now is weare in an open comment period,
which means that anybody itdoesn't matter who you are can
weigh in and submit comments toCMS based on the content of the
proposed changes.
And, as I mentioned before, thecomment period closes on August
(25:47):
29th and we would expect CMS tothen take that time to review
all of the comments received.
Do their analysis make anytweaks they think they will or
will not make?
And we would expect to see afinal rule come out end of
(26:07):
October, early November, and, asCHAP has done in past years,
once that final rule posts, wewill prepare a summary based on
the outcomes of that final rule.
We talked a lot aboutcommenting, Kim, here today, so
(26:28):
what you know beyond commenting,what do you think providers
should be doing with all of thiscontent?
Speaker 2 (26:36):
Well, I think, first and foremost, providers do need
to read the rule, the proposedrule, even though it is very,
very long, and listen towebinars from industry experts,
from the national and stateassociations, to really be able
to condense and understand whatsome of these hot topic areas
(26:59):
are.
But also, for those areas again,go in and see what the language
is and ask any questions againof the, particularly your state
and national associations, ofany specific areas that are
unclear because they are yourprimary advocates, your own
operations and impact orpotential impact that these
(27:21):
changes would make in terms ofimpact to your agency, should
(27:42):
they be finalized.
Again, this is a proposed rule,so there will likely be some
changes associated, you know,between the proposed and the
final, but you do want to beable to identify what those
potential areas of concern areto, or areas of, you know,
(28:03):
improvement, if you will, interms of agency operations, that
you want to be able to submitthose comments Because, as you
said, jennifer, you know CMSlooks for comments, both in the
positive and in the you know thenegative or the concerns, you
know, because they do publishthem all and they do, you know,
(28:28):
respond to each of thosecomments, but if there are no
comments.
They proceed with theinformation that they have.
Speaker 1 (28:35):
Absolutely.
And just a tip if you're goingto go ahead and submit comments
and there's something that youdon't like and you want to
highlight that out in yourletter, it's really great to
include with.
We don't support it with.
Here's some alternatives assome content to include with
(28:58):
items that you're not fully onboard with Absolutely Any final
thoughts.
Speaker 2 (29:04):
That takes us both back to our state and national
association days.
Speaker 1 (29:08):
Yes, Identify a solution, always identify a
solution, absolutely.
Any final thoughts, kim, as weget to the end of our chat cast
today?
Speaker 2 (29:21):
You know, I just think I think we've covered it.
We've covered a lot and youknow we certainly understand
that providers, you know, needto be able to really fully
assimilate this and thesepotential changes.
As an organization, we are hereto support you from a you know,
(29:41):
especially as it relates toareas that are regulatory, and
also certainly any questionsthat you have related to the
(30:01):
COP's changes or other areasthat we can support you with,
and I do know that we will have,you know, updates, we'll have
webinars and additionalinformation ourselves.
But, again, I would recommend,you know, gaining as much
information from differentsources as you can to fully
(30:22):
understand the impact.
Speaker 1 (30:25):
Couldn't agree more, my friend.
Thank you so much.
So, as we round up this chapcast, we would absolutely
encourage you to submit acomment letter to CMS to give
them your thoughts andperspective on some of these
proposed regulatory changes andalso, please share this episode
(30:47):
with your organization andbeyond so that we can make sure
people understand what ishappening, what the timeline
looks like and what the futurelandscape may look like for home
health.
So, thanks to all of you fortaking time out of your day to
plug into our CHAPcast From Kim,me and the entire CHAP staff.
(31:10):
Keep your quality needle movingforward, be compliant, stay
safe and well, and thanks forall you do, thank, you.
Greetings.
I'm Jennifer Kennedy, the leadfor compliance and quality at
CHAP, and welcome to CHAPcast.
Today we're going to be talkingabout the calendar year 2026
home health payment update ruleand I shortened that title
significantly because it is along title for the rule.
(00:21):
But today we're going to justfocus on the home health
provisions in this 591 of a rule, and I'm really so very happy
(01:05):
to be talking about the homehealth provisions with my
colleague and good friend, kimSkian, who is our vice president
for accreditation.
So, kim, wow, big rule.
Speaker 2 (01:21):
That's right and we've read plenty of them, right
, Jennifer?
Speaker 1 (01:26):
Yeah, more than I can count.
I think, and I think you know,for our purposes of doing what
we do and serving our partnersout in the CHAP community, is
dividing this rule into just thehome health provisions and then
dealing with all of the DMEprovisions separately I think
(01:51):
helps, or will help, providersget their head around what CMS
has included in this rule.
And you know, just to be honest, I'm sure providers are feeling
overwhelmed just looking atthis huge document, but it was
overwhelming to read it for sure.
Speaker 2 (02:13):
Absolutely, and the only other thing I would add is
that our focus is on theproposed regulatory and quality
reporting changes.
We will leave the financialanalysis related to payment
updates and PDGM changes toindustry experts, such as the
National Alliance for Healthcareat Home State Association and,
(02:36):
again, industry consulting firmsand experts, Just to provide
further detail, because thereare many changes associated with
the financial impact as wellthat providers do need to ensure
that they understand and reviewand understand the impact for
their agencies.
Speaker 1 (02:57):
Yeah, I can't agree with you more.
You know, we know that in thisproposed rule there's a 6.4%
permanent deduction, or adecrease in the rate for home
health providers proposed forcalendar year or fiscal year
2026.
(03:17):
So that I mean it issignificant and I think you're
spot on with providers lookingto national organizations as
they unpack this rule and lookat all of the financial
parameters that are included andthat will have a significant
impact on home health providersin the space.
(03:39):
We, as you said, kim, you knowthat's really not our scope here
at CHAP, but it doesn't meanit's not important, for sure,
absolutely.
So let's talk about the thingsthat are in our scope and that
you know.
We need to make sure providersunderstand what CMS is proposing
(04:00):
.
And the first thing I'd like tothrow out there is the proposed
changes to the face-to-faceencounter policy.
Speaker 2 (04:09):
You know, I think that this is one of the positive
proposed changes in the ruleand I believe it will be largely
welcomed by home healthproviders and advocates.
In this change, cms is proposingto change the face-to-face
regulation to allow, you know,the physicians in addition to
(04:32):
physicians, nps, nursepractitioners, cnss, and
physician's assistants or PAs toperform that face-to-face
encounter and certification,regardless of whether they are
the certifying practitioner orwhether they cared for the
patient in the acute orpost-acute facility from which
(04:53):
the patient was directlyadmitted to home health and who
is different from the certifyingprovider.
And this proposed change isgoing to align more closely with
the CARES Act implemented as aresult of COVID, by removing
that limitation on whichphysicians are allowed to
complete the face-to-faceencounter and broadening the
(05:13):
number of practitioners who canperform the face-to-face.
It's important, though, to notethat of the other requirements
of the face-to-face, such as thetiming and content, will not be
changed under this rule andfrom a survey perspective, you
know we don't review for thecomponents or technical
(05:34):
compliance with the face-to-face.
However, we do know this is asignificant compliance and
payment issue that has resultedin agency in recruitment of
funds due to technical denialsidentified during CMS or
contractor audits.
So this is a.
(05:54):
It really is a meaningful ifit's finalized, is a meaningful
change for providers change forproviders.
Speaker 1 (06:10):
I agree with that and I'm glad you said if finalized
because everything that we'retalking about today is in
proposed status.
It means that CMS put it outthere we have a 60-day comment
period, which that is on August29th that comments have to be
submitted to CMS.
So CMS has to read all of thosecomments and weigh them and we
(06:36):
could see changes from thisproposed rule to the final.
So thank you for putting it outthere that if it's finalized we
would march forth as it iswritten here or if they make any
kind of tweaks to it based oncomments, correct?
Speaker 2 (06:56):
Absolutely, and that's why comments are so
important, both in support andalso identifying any concerns.
We want to make sure that, evenif a provider supports the
change, that you go on recordand say that, that in the
comment, that you do supportthat change and again, if you
have other recommendations orconcerns, to be able to
(07:18):
highlight them as well.
So, jennifer, in addition, Iknow we talked about
face-to-face, but there are somesignificant proposed changes to
the quality reporting program.
I guess I wouldn't say changes,more significant tweaks to the
quality reporting program.
Do you want to discuss thatjust a little bit?
Speaker 1 (07:43):
Yeah, yeah, and I'm really happy to you know.
Talk about quality, kim.
As you know, at any time wecould talk all day about quality
.
So CMS, in this rule, isproposing to remove the COVID-19
vaccine percentage of patientswho are up to date with the
measure and then thatcorresponding outcome and
(08:06):
assessment information OASISdata element.
Cms would continue to completethe, if this goes through,
complete the OASIS item throughApril 2026.
But it would seem that CMS isnot finding the need to continue
(08:30):
to have that as a measure.
They're also proposing, kim,removal of four social
determinants of healthassessment items in that
standardized patient data set.
It is inclusive of one livingsituation item, two food items
(08:52):
and one utilities items andwe've been seeing this theme
through rulemaking with thefocus coming off of things like
social determinants of healthand health equity that have been
very much up front in pastyears prior to this
administration.
(09:12):
So, given what theadministration changed and
refocused and retooling, we'reseeing things like social
determinants of health andhealth equity fall out of focus
with CMS.
Now they also are proposingsome other things as it relates
(09:44):
to quality and measures as well.
Providers submit a request forreconsideration of an initial
determination of noncomplianceif they can give evidence and
demonstrate full compliance.
What are your thoughts on that?
Speaker 2 (10:01):
Yeah, this is another area that really what CMS is
doing is codifying intoregulation the process that is
in place, that agencies canrequest a reconsideration for
extraordinary services beyondthe agency's control and that
the reconsideration is submittedwithin 30 days of the notice of
(10:22):
noncompliance.
Jennifer, this is similar towhat we see in hospice as well,
where agencies come to the endof the reporting year and then
they receive the letter thatthey're in non-compliance,
meaning that they're below the90% compliance threshold for
(10:47):
submission of in home healthOASIS assessment submission in
the timeframe, oasis assessmentsubmission in the timeframe or
they have not participated inCAPS or submitted an exemption
and largely the reasons that CMSwill overturn.
And I've had some pastexperience with working with
agencies prior to being withCHAP working with agencies on
(11:12):
these reconsiderations andgenerally when CMS says outside
the agency's control, they don'tmean situations where there was
a change in staff or staffwasn't available or the OASIS
error summary reports were notchecked and fatal errors were
not addressed, or if there's atechnology you know concern, or
(11:36):
if an organization is changingEMRs, typically they're looking
at external factors such asweather-related or, you know,
event-related situations thatwould have prohibited this
submission, so there may be someadditional leeway they're going
to define, hopefully, incodifying this regulation, as
(12:00):
far as extraordinarycircumstances, but providers
just need to be aware that,historically, the extraordinary
circumstances are beyond whatwould have been beyond the
agency's control.
Speaker 1 (12:14):
Yeah, you know what.
I'm really glad that theydefine that, you know, because
not all the time you're going tohave a federal declaration of
an emergency event.
It may just happen at the statelevel, but it still interrupts
and impacts operations, right?
So that would be a perfectexample to provide evidence that
you had this event in yourstate, in your area, and you're
(12:39):
requesting that reconsideration.
Speaker 2 (12:43):
And I would just say proactively and currently,
organizations should beregularly reviewing their OASIS
submission reports and the errorsummary to ensure that any
fatal errors are addressed, tobe able to be resubmitted so
that the organization doesremain in compliance.
Speaker 1 (13:05):
Yeah, couldn't agree more.
So also, another inclusion isthat CMS is proposing
implementing a revised HHCAHPSsurvey and they're targeting
that beginning with April 2026sample month.
So when we look at this, it isproposing to remove several
(13:31):
items that they include in themulti-item specific care issues
measure, and three of thoseitems used in the specific care
issues measure would remain inthe HHCAHPS survey instrument.
It is going to be a little bitshorter.
Shorter is always welcome,right, kim?
(13:52):
Absolutely, if you're on thecompletion side of the survey,
so it would be a little bitshorter.
And this is, you know, one ofthose items that is open for
comments in the rule.
So actually I was happy to seethis.
That CMS is, you know, payingattention to monitoring things
(14:14):
like the CAHPS survey to make itmore user-friendly for patients
and families.
Speaker 2 (14:21):
Absolutely, and also another potential welcome change
related to the Home HealthQuality Reporting Program is the
request CMS requesting feedbackon the proposal to reduce data
submission timeframes from fourand a half months to 45 days,
which would improve timelinessand actionability of the quality
(14:45):
measures and help agencies in amore timely response and
implementation of performanceimprovement projects that they
may implement to improve theirmeasures, especially.
You know how this and also howthis may improve timeliness.
Subsequently, timeliness ofpublic reporting of these
(15:05):
measures agrees with thispotential change or update.
Cms is requesting feedback, soplease submit that feedback.
I know that the timeliness andlag time of data, of data you
(15:37):
know and by the time it'ssubmitted and then published in
Home Health Compare is often achallenge for organizations?
Speaker 1 (15:41):
Yeah, absolutely it is, but you know it is what it
is for now.
But I do like this proposal.
I think it is going to behelpful on many different levels
.
We do have one more thing totalk about under measures, kim,
and that is the proposal to theregulatory text to the COPs that
(16:06):
account for all payer datasubmission of OASIS data.
Can you talk a little bit aboutthat?
Speaker 2 (16:12):
Yes, sure, I mean I think this is again.
This is just another update.
This is a change to theconditions of participation,
both 484.45, reporting OASISinformation and 484.55,
comprehensive assessment ofpatients, specifically in
response to the change effectiveJuly 1st of 2025 to account for
(16:36):
all payers' submission of OASISdata.
The change is from the wordpatient to beneficiary because,
again, depending on the payer,the individual served may not be
referred to as a patient.
So this is really a technicalupdate to the COPs.
Speaker 1 (17:03):
Absolutely, and then with any kind of tweak to the
regulatory text in the COPs,that will necessitate a review
and update to the CHAP homehealth standards.
So we'll be awaiting to seewhat that final rule looks like
so that we can make necessarychanges to the CHAP standards,
(17:26):
which you know we'll keepeveryone in the loop on of how
that will roll out.
So, Kim, can we switch gearsand talk a little bit about the
expanded home health value-basedpurchasing model?
There are some changes to theapplicable measure set.
Speaker 2 (17:45):
Yep.
So I will summarize here Againit's been a little bit of time
since I've been heavily involvedin home health value-based
purchasing, but certainly as itrelates to any changes to the
applicable measure set andquality, it is an area that we
(18:05):
do want to make sure that weaddress.
But providers again are reallyit's recommended to hear from,
(18:35):
get the insight from theNational National Alliance for
Health Care at Home and andstate associations and industry
experts who are much more indepth and value based purchasing
, because we know that thissignificantly impacts your
reimbursement.
But some of the proposedchanges include remove as of
April 2026, they're proposing toremove the HCAH, home Health
CAHPS measures related to careof patients, communication
between providers and patientsand specific care issues.
They're also proposing toreduce the six questions on
medications to two questions.
(18:56):
And just there is a table inthe proposed rule it's table 31,
that outlines the current andproposed changes to the Home
Health CAHPS survey measures.
In addition, they again CMS isseeking public comments on the
possibility of initiallymeasuring home health agency
performance on future HCAPinstruments based on achievement
(19:19):
versus achievement andimprovement, which is the
current process.
This also, I believe, will bewelcome news for providers under
the value-based purchasingmodel if implemented, because
you'll be reimbursed basicallysolely on that one factor of
achievement.
In addition, cms is proposingthe addition of four measures to
(19:41):
the applicable measure set.
That are, three OASIS-basedmeasures related to bathing and
dressing that supplement thedischarge function measure, and
one claims-based measure, theMedicare Sp per beneficiary for
post-acute care setting measure.
In addition, cms is proposingto alter the current weights of
these individual measures andmeasure categories in the
(20:02):
value-based purchasing modelbased on these quality reporting
changes.
So the quality reportingchanges don't stand alone right,
especially as it relates tohome health, because it has a
direct impact on not only publicreporting but on reimbursement
through value-based purchasing.
So all of these proposedchanges are worth reviewing,
(20:25):
analyzing the potential impacton your own organization and
operations and then preparingand submitting comments, either
individually or through thestate or national associations.
Jennifer, when I'm looking atthe rule, as we're looking at
the aspects of home health, arethere any requests for
information in this rule thatproviders should be aware of?
Speaker 1 (20:48):
Yeah, kim, there actually are.
There were several requests forinformation or RFIs.
The first one was reallycentered around measure concepts
that are under considerationfor the future of home health.
Cms has really been focused oninteroperability for the last
(21:36):
couple of years, which meansthat how can use and you
probably need to talk to your ITpeople if you're planning on
making comments for thisparticular item.
The next two, wellness andnutrition, and actually
interoperability.
We have seen those three measureconcepts included in the home
health proposed rule that didcome out a few months ago, so it
(21:57):
looks like CMS is duplicatingsome of these RFIs for each rule
that they're putting out thedoor.
Again, wellness and nutritionthey want your feedback about
specific questions that areseated under both of those
topics.
Another item is the RespecifiedFalls with Major Injury measure
(22:21):
, as well as two possiblechanges to the HHCAHPS
survey-based measure scoringrules and applicable measure set
as they relate to the expandedHHVBP model.
So that whole measure conceptpretty big area open for comment
(22:44):
, and I would strongly encourageyou to take a look at that as a
provider and give them thefeedback, because if you don't
give them the feedback, theyjust make assumptions based on
information and data that theyhave.
So we need to give them all ofthe information and data from
your perspective as a providerout there doing it every day, so
(23:08):
that they have that perspective.
Speaker 2 (23:11):
I just want to say that this in particular I just
want to circle back to the fallsat major injury claims-based
measure that you talked about,because this is one that
organization home healthagencies really need to
scrutinize and, you know,consider submission of comments,
(23:33):
because understand that this isa cross-setting measure
currently, which means that itis a measure that is measured
right across all the differentprovider settings that CMS
certifies.
And this is a concern becauseit appears as though the change
(23:54):
that's proposed is seeking tofurther align this measure with
the other provider settings, andthis includes unwitnessed falls
, which might work in a 24-hourcare setting but not necessarily
for home health.
So, again, this deserves morescrutiny and consideration of
submission and comments and thisis why, as much as it's a
(24:16):
591-page rule, you know,subtracting DME, if you're not a
DME provider, this absolutelymust be reviewed and really
evaluate what the potentialimpact is on your own
organization.
Speaker 1 (24:34):
Yeah, I couldn't agree more, and we know that
from CMS's past statements theyare looking to find particular
measures that can be appliedacross the continuum, the
Medicare continuum.
So thanks for pointing that out, for sure.
Speaker 2 (24:50):
Yeah, and not just applied, but potentially
reported, you know in the future.
So, and this is where you knowit really becomes, you know,
important to make sure that thedata is being appropriately
gathered and representative ofthe home health service
(25:12):
locations and providers and thecare that is provided, the type
of care by these providers.
Hey, jennifer, so what happensnow that the proposed rule is
posted?
Speaker 1 (25:24):
that the proposed rule is posted.
So what will happen now is weare in an open comment period,
which means that anybody itdoesn't matter who you are can
weigh in and submit comments toCMS based on the content of the
proposed changes.
And, as I mentioned before, thecomment period closes on August
(25:47):
29th and we would expect CMS tothen take that time to review
all of the comments received.
Do their analysis make anytweaks they think they will or
will not make?
And we would expect to see afinal rule come out end of
(26:07):
October, early November, and, asCHAP has done in past years,
once that final rule posts, wewill prepare a summary based on
the outcomes of that final rule.
We talked a lot aboutcommenting, Kim, here today, so
(26:28):
what you know beyond commenting,what do you think providers
should be doing with all of thiscontent?
Speaker 2 (26:36):
Well, I think, first and foremost, providers do need
to read the rule, the proposedrule, even though it is very,
very long, and listen towebinars from industry experts,
from the national and stateassociations, to really be able
to condense and understand whatsome of these hot topic areas
(26:59):
are.
But also, for those areas again,go in and see what the language
is and ask any questions againof the, particularly your state
and national associations, ofany specific areas that are
unclear because they are yourprimary advocates, your own
operations and impact orpotential impact that these
(27:21):
changes would make in terms ofimpact to your agency, should
(27:42):
they be finalized.
Again, this is a proposed rule,so there will likely be some
changes associated, you know,between the proposed and the
final, but you do want to beable to identify what those
potential areas of concern areto, or areas of, you know,
(28:03):
improvement, if you will, interms of agency operations, that
you want to be able to submitthose comments Because, as you
said, jennifer, you know CMSlooks for comments, both in the
positive and in the you know thenegative or the concerns, you
know, because they do publishthem all and they do, you know,
(28:28):
respond to each of thosecomments, but if there are no
comments.
They proceed with theinformation that they have.
Speaker 1 (28:35):
Absolutely.
And just a tip if you're goingto go ahead and submit comments
and there's something that youdon't like and you want to
highlight that out in yourletter, it's really great to
include with.
We don't support it with.
Here's some alternatives assome content to include with
(28:58):
items that you're not fully onboard with Absolutely Any final
thoughts.
Speaker 2 (29:04):
That takes us both back to our state and national
association days.
Speaker 1 (29:08):
Yes, Identify a solution, always identify a
solution, absolutely.
Any final thoughts, kim, as weget to the end of our chat cast
today?
Speaker 2 (29:21):
You know, I just think I think we've covered it.
We've covered a lot and youknow we certainly understand
that providers, you know, needto be able to really fully
assimilate this and thesepotential changes.
As an organization, we are hereto support you from a you know,
(29:41):
especially as it relates toareas that are regulatory, and
also certainly any questionsthat you have related to the
(30:01):
COP's changes or other areasthat we can support you with,
and I do know that we will have,you know, updates, we'll have
webinars and additionalinformation ourselves.
But, again, I would recommend,you know, gaining as much
information from differentsources as you can to fully
(30:22):
understand the impact.
Speaker 1 (30:25):
Couldn't agree more, my friend.
Thank you so much.
So, as we round up this chapcast, we would absolutely
encourage you to submit acomment letter to CMS to give
them your thoughts andperspective on some of these
proposed regulatory changes andalso, please share this episode
(30:47):
with your organization andbeyond so that we can make sure
people understand what ishappening, what the timeline
looks like and what the futurelandscape may look like for home
health.
So, thanks to all of you fortaking time out of your day to
plug into our CHAPcast From Kim,me and the entire CHAP staff.
(31:10):
Keep your quality needle movingforward, be compliant, stay
safe and well, and thanks forall you do, thank, you.
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