Read theMandate
Menu

Documents › Agency rules › 2025-21767

Health and Human Services Department, Centers for Medicare & Medicaid Services

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

Published December 2, 2025. Takes effect January 1, 2026, printed at 90 FR 55342, amending 42 CFR 405, 42 CFR 414, 42 CFR 424, 42 CFR 455. 226,865 words.

In plain English

This sets what Medicare pays for care given in the home.

Read it at the Federal Register →

What the Rule Says It Does

This final rule sets forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this final rule finalizes permanent and temporary behavior adjustments and recalibrates the case- mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. This final rule also finalizes changes to the face-to-face encounter policy and changes to the Home Health Quality Reporting Program (HH QRP) and the expanded Health Value-Based Purchasing (HHVBP) Model requirements. In addition, it updates the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). Lastly it finalizes: 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.

This is the rule's own summary, as the Federal Register prints it.

The Order It Names

The rule names this order itself. What it does about it is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 90, Number 229 (Tuesday, December 2, 2025)] [Rules and Regulations] [Pages 55342-55620] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2025-21767]

Vol. 90

Tuesday,

No. 229

December 2, 2025

Part II

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 414, 424 et al.

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; Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 414, 424, 455, 484, and 498

[CMS-1828-F] RIN 0938-AV53

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

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Final rule.

DATES

These regulations are effective on January 1, 2026.

FOR FURTHER INFORMATION CONTACT

For general information about the Home Health Prospective Payment System (HH PPS), send your inquiry via email to [email protected].

For information about the Home Health Quality Reporting Program (HH QRP), send your inquiry via email to [email protected].

For more information about the expanded Home Health Value-Based Purchasing Model (HHVBP), please visit the Expanded HHVBP Model web page at https://www.cms.gov/priorities/innovation/innovation-models/expanded-home-health-value-based-purchasing-model or send your inquiry via email to [email protected].

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 [email protected], for DMEPOS Competitive Bidding Program inquiries.

For information about the Home Health Conditions of Participation, send your inquiry via email to [email protected].

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

Table of Contents

I. Executive Summary

A. Purpose and Legal Authority

B. Summary of the Provisions of This Final Rule

C Summary of the Regulatory Impact Analysis II. Home Health Prospective Payment System

A. Overview of the Home Health Prospective Payment System

B. Monitoring the Effects of the Implementation of the PDGM

C. Final CY 2026 Payment Adjustments Under the HH PPS

D. Final CY 2026 Home Health Low Utilization Payment Adjustment (LUPA) Thresholds, Functional Impairment Levels, Comorbidity Sub- Groups, and Case-Mix Weights

E. Final CY 2026 Home Health Payment Rate Updates

F. Final Regulation Change to Face-to-Face Encounter III. Home Health Quality Reporting Program (HH QRP)

A. Background and Statutory Authority

B. Summary of the Provisions

C. Quality Measures Currently Adopted for the CY 2026 HH QRP

D. 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

E. Removal of Four Standardized Patient Assessment Data Elements Beginning With the CY 2026 HH QRP

F. Amending the Data Non-Compliance Reconsideration Request Policy and Process Beginning With the CY 2026 HH QRP

G. Updates to Requirements for OASIS All-Payer Data Submission

H. HHCAHPS Survey Updates

I. HH QRP Quality Measure Concepts Under Consideration for Future Years--Request for Information

J. Potential Revision of the Final Data Submission Deadline Period From 4.5 Months to 45 Days--Request for Information (RFI)

K. Advancing Digital Quality Measurement in the HH QRP--Request for Information

L. Form, Manner, and Timing of Data Submission Under the HH QRP

M. Policies Regarding Public Display of Measure Data for the HH QRP IV. The Expanded Home Health Value-Based Purchasing (HHVBP) Model

A. Background

B. Finalized Changes to HHVBP Measure Removal Factors

C. Finalized Changes to the Expanded HHVBP Model's Applicable Measure Set

D. HHVBP Quality Measure Concepts Under Consideration for Future Years--Request for Information V. Updates to the Home Health Agency Conditions of Participation (CoPs) To Align With the OASIS All-Payer Submission Requirements

A. Statutory Authority and Background

B. Updates to the Home Health Agency CoPs To Align With the OASIS All-Payer Submission Requirements (Sec. Sec. 484.45(a) and 484.55(d)(1)(i)) VI. Provider Enrollment, Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation Policies, and DMEPOS Prior Authorization

A. Provider Enrollment

B. DMEPOS Supplier Accreditation Process

C. Finalized Exemption Process for Prior Authorization of Certain DMEPOS Items (Sec. 414.234(c)(1) and (c)(1)(ii)) VII. DMEPOS Competitive Bidding Program

A. Background

B. Determining Payment Amounts and the Number of Contracts Awarded for the DMEPOS CBP

C. Adjustments to SPAs

D. Bid Limits and Conditions for Awarding Contracts if Savings Are Not Expected

E. Revising the Definition of Item Related to Medical Supplies

F. Remote Item Delivery (RID) CBP

G. Payment for Continuous Glucose Monitors and Insulin Infusion Pumps

H. Revising the Submission of Financial Document Requirements for the DMEPOS CBP

I. Revising the CDRD Evaluation and Notification Process for the DMEPOS CBP

J. Bid Surety Bond Review Process

K. Tribal Exemption From Participating in the DMEPOS CBP

L. Addition of a Termination Clause for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) Supplier Contracts

M. Technical Change to Sec. 414.408(h)(8)

N. Definitions of Competition and Adjusted and Unadjusted Fee Schedule Amounts Under Sec. 414.402 VIII. Collection of Information Requirements

A. Statutory Requirement for Solicitation of Comments

B. Information Collection Requirements (ICRs) IX. Regulatory Impact Analysis

A. Statement of Need

B. Overall Impact

C. Detailed Economic Analysis

D. Regulatory Review Cost Estimation

E. Alternatives Considered

F. Accounting Statements and Tables

G. Regulatory Flexibility Act (RFA)

H. Unfunded Mandates Reform Act (UMRA)

I. Federalism

J. Unleashing Prosperity Through Deregulation

K. Conclusion X. Response to Comments

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 104 headings, 226,865 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 3 words
  3. SUMMARYOn its face · 137 words
  4. DATESOn its face · 9 words
  5. FOR FURTHER INFORMATION CONTACTOn its face · 137 words
  6. SUPPLEMENTARY INFORMATIONPreamble · 2 words
  7. Table of ContentsPreamble · 3 words
  8. I. Executive SummaryPreamble · 606 words
  9. I. Executive SummaryPreamble · 3 words
  10. A. Purpose and Legal AuthorityPreamble · 5 words
  11. 1. Home Health Prospective Payment System (HH PPS)Preamble · 2,042 words
  12. m. Adding Definitions of Adjusted Fee Schedule, Amount Competition, and Unadjusted Fee Schedule Amount to Sec. 414.402.Preamble · 47 words
  13. B. Summary of the Provisions of This Final RulePreamble · 9 words
  14. 1. Home Health Prospective Payment System (HH PPS)Preamble · 2,902 words
  15. C. Summary of the Regulatory Impact AnalysisPreamble · 21 words
  16. II. Home Health Prospective Payment SystemPreamble · 6 words
  17. A. Overview of the Home Health Prospective Payment SystemPreamble · 9 words
  18. 1. Statutory BackgroundPreamble · 1,678 words
  19. B. Monitoring the Effects of the Implementation of the PDGMPreamble · 10 words
  20. 1. Routine PDGM MonitoringPreamble · 222 words
  21. C. CY 2026 Payment Adjustments Under the HH PPSPreamble · 1,821 words
  22. e. Applying the Methodology to CY 2024 Data To Determine the CY 2026 Permanent and Temporary AdjustmentsPreamble · 1,086 words
  23. f. CY 2026 Permanent Adjustment and Temporary Adjustment CalculationsPreamble · 9,522 words
  24. 1. Final CY 2026 PDGM LUPA ThresholdsPreamble · 5,720 words
  25. E. CY 2026 Home Health Payment Rate UpdatesPreamble · 8 words
  26. 1. Final CY 2026 Home Health Market Basket Update for HHAsPreamble · 8,076 words
  27. c. Final CY 2026 National Per-Visit Rates for 30-Day Periods of CarePreamble · 3,601 words
  28. F. Change to Face-to-Face Encounter RegulationsPreamble · 3,076 words
  29. III. Home Health Quality Reporting Program (HH QRP)Preamble · 8 words
  30. A. Background and Statutory AuthorityPreamble · 270 words
  31. B. Summary of the ProvisionsPreamble · 366 words
  32. C. Quality Measures Currently Adopted for the CY 2026 HH QRPPreamble · 1,270 words
  33. E. Removal of Four Standardized Patient Assessment Data Elements Beginning With the CY 2026 HH QRPPreamble · 1,715 words
  34. F. Amending the Data Non-Compliance Reconsideration Request Policy and Process Beginning With the CY 2026 HH QRPPreamble · 17 words
  35. 1. BackgroundPreamble · 1,772 words
  36. G. Updates to Requirements for OASIS All-Payer Data SubmissionPreamble · 9 words
  37. 1. Statutory Authority and BackgroundPreamble · 879 words
  38. H. HHCAHPS Survey UpdatesPreamble · 4 words
  39. a. Survey and Measure ChangesPreamble · 3,113 words
  40. I. HH QRP Quality Measure Concepts Under Consideration for Future Years--Request for Information (RFI)Preamble · 315 words
  41. 2. Cognitive FunctionPreamble · 344 words
  42. 3. Well-BeingPreamble · 94 words
  43. 4. NutritionPreamble · 139 words
  44. 1. InteroperabilityPreamble · 1,481 words
  45. J. Potential Revision of the Final Data Submission Deadline Period From 4.5 Months to 45 Days--Request for Information (RFI)Preamble · 1,227 words
  46. K. Advancing Digital Quality Measurement in the HH QRP--Request for InformationPreamble · 1,711 words
  47. L. Form, Manner, and Timing of Data Submission Under the HH QRPPreamble · 35 words
  48. M. Policies Regarding Public Display of Measure Data for the HH QRPPreamble · 12 words
  49. 1. Ending the Public Display of Patient/Resident COVID-19 MeasurePreamble · 243 words
  50. IV. The Expanded Home Health Value-Based Purchasing (HHVBP) ModelPreamble · 9 words
  51. A. BackgroundPreamble · 533 words
  52. B. Changes to HHVBP Measure Removal FactorsPreamble · 212 words
  53. C. Changes to the Expanded HHVBP Model's Applicable Measure SetPreamble · 918 words
  54. 2. Addition of Medicare Spending Per Beneficiary Post-Acute Care (MSPB- PAC) to the Expanded HHVBP Model Applicable Measure SetPreamble · 5,142 words
  55. D. HHVBP Quality Measure Concepts Under Consideration for Future Years--Request for InformationPreamble · 1,692 words
  56. V. Updates to the Home Health Agency Conditions of Participation (CoPs) To Align With the OASIS All-Payer Submission RequirementsPreamble · 19 words
  57. A. Statutory Authority and BackgroundPreamble · 1,159 words
  58. VI. Provider Enrollment and Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation PoliciesPreamble · 15 words
  59. A. Provider EnrollmentPreamble · 15,120 words
  60. B. DMEPOS Supplier Accreditation ProcessPreamble · 7,643 words
  61. 4. Ongoing Responsibilities of a CMS-Approved AO (New Sec. 424.58(e))Preamble · 31,314 words
  62. C. Exemption Process for Prior Authorization of Certain DMEPOS Items (Sec. 414.234(c)(1) and (c)(1)(ii))Preamble · 14 words
  63. 1. BackgroundPreamble · 1,664 words
  64. VII. DMEPOS Competitive Bidding ProgramPreamble · 5 words
  65. A. BackgroundPreamble · 3,112 words
  66. B. Determining Payment Amounts and the Number of Contracts Awarded for the DMEPOS CBPPreamble · 16,618 words
  67. C. Adjustments to SPAsPreamble · 828 words
  68. D. Bid Limits and Conditions for Awarding Contracts if Savings Are Not ExpectedPreamble · 4,636 words
  69. E. Revising the Definition of “Item” Related to Medical SuppliesPreamble · 1,919 words
  70. 3. Provisions of the RegulationPreamble · 1,859 words
  71. F. Remote Item Delivery (RID) CBPPreamble · 7,090 words
  72. G. Payment for Continuous Glucose Monitors and Insulin Infusion PumpsPreamble · 5,333 words
  73. a. Medicare Part B Payment for Class III CGMs and Insulin Pumps Used in Conjunction With Class III CGMsPreamble · 9,546 words
  74. H. Revising the Submission of Financial Document Requirements for the DMEPOS CBPPreamble · 12 words
  75. 1. BackgroundPreamble · 5,942 words
  76. I. Revising the CDRD Evaluation and Notification Process for the DMEPOS CBPPreamble · 12 words
  77. 1. BackgroundPreamble · 1,042 words
  78. J. Bid Surety Bond Review ProcessPreamble · 6 words
  79. 1. BackgroundPreamble · 2,372 words
  80. K. Tribal Exemption From Participating in the DMEPOS CBPPreamble · 9 words
  81. 1. BackgroundPreamble · 763 words
  82. 1. BackgroundPreamble · 1,884 words
  83. M. Technical Change to Sec. 414.408(h)(8)Preamble · 161 words
  84. N. Definitions of “Competition” and “Adjusted Fee Schedule Amount” and “Unadjusted Fee Schedule Amount” Under Sec. 414.402Preamble · 321 words
  85. VIII. Collection of Information RequirementsPreamble · 5 words
  86. A. Statutory Requirement for Solicitation of CommentsPreamble · 136 words
  87. B. Information Collection Requirements (ICRs)Preamble · 9,477 words
  88. VIII. Waiver of Delay in Effective DatePreamble · 414 words
  89. IX. Regulatory Impact AnalysisPreamble · 4 words
  90. A. Statement of NeedPreamble · 4 words
  91. 1. HH PPSPreamble · 1,596 words
  92. B. Overall ImpactPreamble · 362 words
  93. C. Detailed Economic AnalysisPreamble · 4 words
  94. 1. Effects of the Changes for the CY 2026 HH PPSPreamble · 8,409 words
  95. D. Regulatory Review Cost EstimationPreamble · 296 words
  96. E. Alternatives ConsideredPreamble · 3 words
  97. 1. HH PPSPreamble · 1,655 words
  98. F. Accounting Statements and TablesPreamble · 40 words
  99. G. Regulatory Flexibility Act (RFA)Preamble · 1,791 words
  100. H. Unfunded Mandates Reform Act (UMRA)Preamble · 89 words
  101. I. FederalismPreamble · 71 words
  102. J. Unleashing Prosperity Through DeregulationPreamble · 52 words
  103. K. ConclusionPreamble · 141 words
  104. List of SubjectsRegulatory text · 17,399 words

The Rest of the Text

This rule runs to 226,865 words. The rest of it is set out over 15 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, “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,” 90 FR 55342 (December 2, 2025). Effective January 1, 2026.
    https://www.federalregister.gov/documents/2025/12/02/2025-21767/medicare-and-medicaid-programs-calendar-year-2026-home-health-prospective-payment-system-hh-pps-rate

  2. This page

    “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,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2025-21767/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 15 pages rather than one.

Two things the Register prints are not reproduced: the running head it repeats at every page break, and the tables it sets as pictures rather than as words. Its own marker for one of those tables, [GRAPHIC] [TIFF OMITTED], is left standing where the table was, so a reader can see that something is there and follow the link to the page it is on.

A heading with nothing quoted under it is one the rule prints on its own, with the words that follow it set under the headings beneath.