Federal Home Health and Hospice Updates
(Nov. 25, 2025) Please see the following home health and hospice updates from LeadingAge National:
Home Health Updates
Home Health Member Network December 2. LeadingAge will host our next home health member network on Tuesday, December 2 at 2 p.m. ET. We anticipate the CY2026 Home Health Final Rule will be published by that time and we will spend the meeting discussing the final rule content in depth. Members can sign up for the call here.
Long Awaited Home Health OASIS Guidance Wins and Losses. Guidance published on November 20 by the Centers for Medicare and Medicaid Services (CMS) finally clarifies that OASIS does not need to be collected for outpatient therapy services provided by a home health agency but billed under Medicare Part B for a patient without a home health plan of care. This is a huge win for home health agencies without patient therapy practices, reducing the burden of data collection. However, the guidance also includes responses to questions about OASIS submission for non-billable visits when a patient has been seen by two separate HHAs. CMS clarifies that if the patient does not meet any of the OASIS exemptions and more than one visit was made, the comprehensive assessment including OASIS is required for both the Start of Care and Discharge even if one or more of the visits were non-billable due to duplication of services. CMS also announced that effective January 1, 2026 the definition of a fall for J1800 has been adjusted which will result in a change in definition for M1033- Risk for Hospitalization will be updated and defined to state "A fall due to an overwhelming external force (e.g., a patient pushing another patient) would be considered a fall" and "If a major injury results from a fall or intercepted fall that occurs when a clinician is intentionally challenging a patient's balance during balance training, it would be considered a fall for M1033". This is a huge deviation from previous guidance which did not consider this a fall. LeadingAge will have a full analysis of all the OASIS updates in the coming week.
Home Health October Care Compare Refresh Now Live! Due to the government shutdown, scheduled data refreshes from the Centers for Medicare and Medicaid Services (CMS) were temporarily paused. With the resumption of government operations on November 13, these updates are being released. Effective November 20, 2025, the October 2025 refresh of the Home Health Quality Reporting Program is now available on the compare tool on Medicare.gov and Provider Data Catalog (PDC). The data are based on quality assessment data submitted by home health agencies (HHAs) from Quarter 1, 2024 through Quarter 4, 2024. The data for the claims-based measures will display data from Quarter 1, 2023 through Quarter 4, 2024 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2022 through Quarter 4, 2024 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2024 through Quarter 4, 2024 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 2, 2024 through Quarter 1, 2025. However, CMS shares that due to technical issues that affected two quality measures, CMS has decided to suppress the measure results for the Transfer of Health Information to the Provider and Discharge Function Score measures (which is used in the Home Health Value Based Purchasing Program) for the October 2025 release. Reporting on the two measures will resume with the next refresh in January 2026.
CMS Posts Home Health Quality and Star Rating Preview Reports for January 2026. Due to the lapse in federal appropriations, scheduled data refreshes and other routine updates were temporarily paused. With the resumption of government operations on November 13, the HHA Provider Preview Reports updates are now being released in iQIES. These reports contain provider performance scores for quality measures to be published on Care Compare in January 2026. Data contained within the Provider Preview Reports are based on quality assessment data submitted by HHAs from Quarter 2, 2024 through Quarter 1, 2025. The data for the claims-based measures will display data from Quarter 1, 2023 through Quarter 4, 2024 for the Discharge to Community and Medicare Spending Per Beneficiary measures, Quarter 1, 2022 through Quarter 4, 2024 for the Potentially Preventable 30-Day Post-Discharge Readmission measure, and Quarter 1, 2024 through Quarter 4, 2024 for the Home Health Within-Stay Potentially Preventable Hospitalization measure. Additionally, the data for the HHCAHPS measures will display data from Quarter 3, 2024 through Quarter 2, 2025. The Preview Reports for the January 2026 release include one new OASIS-based measure, COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date, based on quality assessment data from Quarter 1, 2025. This measure was proposed for removal in the CY2026 Home Health Rule which has not yet been published.
OIG Adds Home Health Outlier Payments to Their Workplan. On November 18, the Office of Inspector General (OIG) added a new item to their workplan which will look at "Incorrectly Billed Visit Units That Trigger Outlier Payments on Home Health Claims" with the objective to determine whether home health claims outlier payments complied with certain Medicare billing requirements. This work comes after previous compliance work identified claims where home health providers incorrectly billed single-discipline visit units (greater than 8 hours) that resulted in overpayments equal to the outlier payment. Medicare Administrative Contractors (MACs) pay outlier payments on home health claims for enrollees who incur unusually large costs that are determined by the visit units billed on the claim. Nationwide home health claims data for the most recent 30-month period shows that the average duration of a home health visit is 45 minutes. OIG anticipates the work on this issue to be completed by FY2027.
Department of Education Proposes Narrower Definition of “Professional Degrees.” The U.S. Department of Education (DOE) has proposed revisions to the definition of “professional degree” that could have implications for federal student loan eligibility for certain graduate programs. This development is part of a negotiated rulemaking process that concluded recently aimed at implementing certain provisions of H.R. 1. Programs potentially excluded from the revised definition include positions vital to the aging services sector, including nursing and social work. Students in these fields could face reduced federal loan options and potential barriers to pursuing advanced credentials as a result of these changes. DOE will issue a Notice of Proposed Rulemaking (NPRM) soon, followed by a public comment period. Final rules are expected to take effect on July 1, 2026. LeadingAge will continue to monitor developments and share opportunities for member input.
Update on Medicare Claims Impacted by Government Shutdown. The Centers for Medicare & Medicaid Services (CMS) issued an update on November 21 on Medicare claims processing impacted by the federal government shutdown. CMS has instructed Medicare Administrative Contractors (MACs) to make payment adjustments to any claims paid during the shutdown that are now inconsistent with the most recent Congressional action. CMS further encourages practitioners to submit any telehealth claims that were held during the shutdown or resubmit any telehealth claims that were returned as unpayable under law during the shutdown. More information can be found here. CMS notes that practitioners, providers, and suppliers should observe a return to normal claims processing in the coming days.
Slate of Medicare Advantage Reform Bills Introduced. Congressman Mark Pocan (D-WI), along with 12 other members of the House, introduced a package of eight bills on November 19 that seek to restrain certain Medicare Advantage plan practices and strengthen the core Medicare program. The bills would establish a series of new requirements for MA plans including requiring: automatic appeals to be processed without beneficiary action when a prior authorization is denied, CMS to terminate MA plans if more than 25% of their prior authorization denials are reversed upon appeal, plans to disclose their coverage determination delay and denial rates when they advertise their plans. The bills also target MA companies that it says are overcharging taxpayers. One bill would prohibit MA from becoming the default enrollment option for Medicare beneficiaries and another calls for CMS to create a national, user-friendly website where individuals can look up their healthcare providers by insurance plan. LeadingAge will follow these bills closely and look forward to engaging with the sponsors on their content.
CMS Updates Guidance on Telehealth for CY 2026. On November 14, the Centers for Medicare and Medicaid Services (CMS) released updated FAQs on telehealth in Calendar Year (CY) 2026 for Medicare providers. Much of the information is consistent with previous guidance on waivers for geographic restrictions, originating site, audio-only, and expanded providers which were extended with the legislation to reopen the government until January 30, 2026. CMS reiterates that the Consolidated Appropriations Act of 2021 permanently removed geographic, place of service, and audio-only restrictions for behavioral health telehealth services. However, the CY2026 Physician Fee Schedule Final Rule also made substantial changes to telehealth rules which are captured in this new FAQ. These changes include the removal of frequency limitations on telehealth services for inpatient and skilled nursing, adoption of teaching physician supervision via telecommunications, and established a new process for requests to add services to the Medicare Telehealth Services List. The FAQs also clarified that Rural Health Centers and Federally Qualified Health Centers can bill for non-behavioral health services furnished through telecommunications until December 31, 2026, by using the HCPCS code G2025 on claims. The home may continue to serve as a distant site for beneficiaries receiving telecommunications services furnished by RHCs and FQHCs.
2026 Medicare Premiums, Deductibles Increase More than Social Security COLA. On Wednesday, November 19, the 2026 Medicare premiums, deductibles and other cost sharing that beneficiaries will incur will be published in the Federal Register. Part A costs increased about 3.5% across the board, while the standard Part B premiums increased 9.7% to $202.90 per month. Medicare coinsurance in skilled nursing facilities for days 21 - 100 will be $217 per day. These increases exceed the 2.8% cost of living adjustment (COLA)for Social Security Income that was also recently announced. For all the details, check out this LeadingAge article.
Hospice Updates
CMS Makes Changes to Hospice Care Index Calculations. On November 18, the Centers for Medicare and Medicaid Services (CMS) announced updates to the calculation of the Hospice Care Index (HCI) Measure. CMS identified and corrected an issue affecting how the Late Live Discharge and Early Live Discharge indicators were calculated within the HCI measure. The correction was applied to the programming logic used in calculating these indicators to ensure that each hospice’s score reflects only the care it provided to its own patients. This correction affects a small percentage of hospice providers. Archived data will be updated with the corrected methodology in a future release.
CMS Posts Hospice Quality Preview Reports for February 2026. Due to the lapse in federal appropriations, scheduled data refreshes and other routine updates were temporarily paused. With the resumption of government operations on November 13, the Hospice Provider Preview Reports are now being released on CASPER. These reports contain provider performance scores for quality measures to be published on Care Compare in February 2026. In the Provider Preview Reports, assessment-based measure scores are based on HIS data submitted by hospices from Quarter 2, 2024 through Quarter 1, 2025. CAHPS measure scores are based on CAHPS data submitted from Quarter 2, 2023 through Quarter 1, 2025. CAHPS Star Ratings are calculated based on data from Quarter 2, 2023 through Quarter 1, 2025. The claims-based measures reflect claims data collected from Quarter 1, 2023 through Quarter 4, 2024.
CMS Updates Guidance on Telehealth for CY 2026. On November 14, the Centers for Medicare and Medicaid Services (CMS) released updated FAQs on telehealth in Calendar Year (CY) 2026 for Medicare providers. Much of the information is consistent with previous guidance on waivers for geographic restrictions, originating site, audio-only, and expanded providers which were extended with the legislation to reopen the government until January 30, 2026. CMS reiterates that the Consolidated Appropriations Act of 2021 permanently removed geographic, place of service, and audio-only restrictions for behavioral health telehealth services. However, the CY2026 Physician Fee Schedule Final Rule also made substantial changes to telehealth rules which are captured in this new FAQ. These changes include the removal of frequency limitations on telehealth services for inpatient and skilled nursing, adoption of teaching physician supervision via telecommunications, and established a new process for requests to add services to the Medicare Telehealth Services List. The FAQs also clarified that Rural Health Centers and Federally Qualified Health Centers can bill for non-behavioral health services furnished through telecommunications until December 31, 2026, by using the HCPCS code G2025 on claims. The home may continue to serve as a distant site for beneficiaries receiving telecommunications services furnished by RHCs and FQHCs.
Update on Medicare Claims Impacted by Government Shutdown. The Centers for Medicare & Medicaid Services (CMS) issued an update on November 21 on Medicare claims processing impacted by the federal government shutdown. CMS has instructed Medicare Administrative Contractors (MACs) to make payment adjustments to any claims paid during the shutdown that are now inconsistent with the most recent Congressional action. CMS further encourages practitioners to submit any telehealth claims that were held during the shutdown or resubmit any telehealth claims that were returned as unpayable under law during the shutdown. More information can be found here. CMS notes that practitioners, providers, and suppliers should observe a return to normal claims processing in the coming days.
Department of Education Proposes Narrower Definition of “Professional Degrees.” The U.S. Department of Education (DOE) has proposed revisions to the definition of “professional degree” that could have implications for federal student loan eligibility for certain graduate programs. This development is part of a negotiated rulemaking process that concluded recently aimed at implementing certain provisions of H.R. 1. Programs potentially excluded from the revised definition include positions vital to the aging services sector, including nursing and social work. Students in these fields could face reduced federal loan options and potential barriers to pursuing advanced credentials as a result of these changes. DOE will issue a Notice of Proposed Rulemaking (NPRM) soon, followed by a public comment period. Final rules are expected to take effect on July 1, 2026. LeadingAge will continue to monitor developments and share opportunities for member input.
2026 Medicare Premiums, Deductibles Increase More than Social Security COLA. On Wednesday, November 19, the 2026 Medicare premiums, deductibles and other cost sharing that beneficiaries will incur will be published in the Federal Register. Part A costs increased about 3.5% across the board, while the standard Part B premiums increased 9.7% to $202.90 per month. Medicare coinsurance in skilled nursing facilities for days 21 - 100 will be $217 per day. These increases exceed the 2.8% cost of living adjustment (COLA)for Social Security Income that was also recently announced. For all the details, check out this LeadingAge article.
Contact: Meg Everett, meverett@leadingageny.org