Home Health Value-Based Purchasing (HHVBP) in 2026: The 5% Nobody Is Managing

Key Takeaways

• The expanded HHVBP Model covers Medicare-certified HHAs in all 50 states, DC, and the U.S. territories, under section 1115A authority, with the adjustment methodology codified at 42 CFR 484.370.
• The adjustment ranges from -5% to +5%, applied per final Medicare FFS claim with a payment episode through-date in the payment year — not to aggregate revenue.
• Adjustments are budget neutral across the cohort via a linear exchange function. Your score is relative; the pool is fixed.
• CY 2026 is the fourth performance year and sets the CY 2028 adjustment. CY 2025 performance sets CY 2027.
• CY 2026 measure weights: OASIS-based 40%, claims-based 40%, HHCAHPS 20% for the larger-volume cohort; 50/50/0 for the smaller-volume cohort.
• The CY 2026 baseline year is CY 2023 for all measures except DTC-PAC and MSPB-PAC, which use CY 2022 and CY 2023.
• CY 2026 report calendar: Preview APR August 20, Preliminary APR October 1, Final APR November 25, 2026. Recalculation requests are due 15 calendar days after the Preview APR.
• An agency needs at least 5 quality measures and a prior payment year amount to receive a Total Performance Score and an adjustment at all.
• The CY 2027 proposed rule proposes no HHVBP-specific policy changes — the model as configured is the model you are being scored against.

How the Model Actually Works

HHVBP is a relative-performance model. You are not scored against a fixed standard; you are scored against agencies like you, for a fixed pool of money.

Cohort assignment

CMS assigns every HHA to a nationwide larger-volume cohort or a nationwide smaller-volume cohort based on unique beneficiary count in the prior calendar year. A small agency is not measured against a national chain — but it is measured against every other small agency in the country, which is a far wider field than most operators picture. Cohort assignment also determines your measure set: the smaller-volume cohort is not scored on HHCAHPS at all, which redistributes that 20% across the OASIS and claims categories.

Budget neutrality is the part people miss

Payment adjustments are applied in a budget-neutral manner within each cohort. Amounts above the 5% ceiling are redistributed inside the cohort. That means improvement alone does not guarantee a positive adjustment — improvement relative to your cohort does. An agency that gets meaningfully better in a year when everyone else got better at the same pace can still land flat.

The performance-year to payment-year lag

The two-year lag is the single most misunderstood feature of the model. The care you deliver today does not affect this year's payment — it affects payment two years out. An agency reacting to a bad adjustment is already two years behind the data that caused it.

The CY 2026 Measure Set and Weights

This is the table most agencies have never seen, and it is the one that tells you where to spend management attention.

Source: CMS, CY 2026 Measures and Reports At-A-Glance.

Three things fall out of that table immediately. Discharge Function Score alone carries 15% in the larger-volume cohort — equal to PPH and DTC-PAC, and more than four times the weight of any single bathing or dressing measure. The three new dressing and bathing measures together carry only 7%, so they are worth fixing but not worth reorganizing around. And MSPB-PAC at 10% makes your score partly dependent on Medicare spending you do not control, including care delivered after your episode ends.

Baselines and reporting periods

The CY 2026 Report Calendar

CMS publishes dates. Most agencies discover them after the fact.

Two procedural traps live in that table. The reconsideration step is only available to agencies that filed a recalculation request first — skip step one and step two disappears. And the Final APR is issued no later than 30 days before the adjustment takes effect, which means by the time you see the final number, there is nothing left to do about it.

Two data changes that moved scores this year

CMS corrected an iQIES risk-adjustment processing error in early April 2026: CY 2025 start-of-care and resumption-of-care episodes had been calculated with 2024 risk-adjustment coefficients in the July 2025, October 2025, and January 2026 Interim Performance Reports. CMS's impact analysis found small changes in agency-level OASIS measure scores.

Separately, claims-based measure updates first appeared in the July 2026 IPRs and carry into the CY 2026 APRs: the Medicare Beneficiary Identifier replaced the HICN, the DTC-PAC lookback shortened from 180 days to 90 days, and ICD-10 and HCC code lists were updated for FY 2026. CMS reported before-and-after correlations of 0.98 for DTC-PAC and 0.97 for PPH — high, but not identical. If your DTC-PAC score moved without an operational cause, the lookback change is the first place to look.

Where the Money Is

The maximum adjustment is plus or minus 5%, applied per Medicare FFS claim in the payment year.

Illustrative maximum-range calculation on a flat Medicare FFS base. Actual adjustments depend on Total Performance Score relative to cohort and are applied per claim.

Set that against the CY 2027 proposed rule's +2.1% payment update and -3.0% temporary PDGM adjustment and the ordering is clear: the HHVBP swing is larger than the rate update and larger than the clawback. It is the biggest single controllable variable in home health Medicare revenue, and the one most agencies manage least actively.

For context on whether the model delivers, the published evaluation results are from the original nine-state HHVBP Model (2016-2021), not the expanded one: an average 4.6% improvement in total performance scores and average annual Medicare savings of $141 million, without evidence of adverse risk. CMS has not published an equivalent aggregate evaluation of the expanded model, and it does not publish the distribution of payment adjustments across agencies. Anyone quoting a savings figure for the expanded model is quoting the old one.

Modeling the rate update, the temporary adjustment, HHVBP, and case-mix drift together is the only way to see the real number, and that reconciliation belongs alongside Medicare cost report filing rather than in a spreadsheet nobody updates.

What to Do With Your Reports

• Download the Preview and Preliminary APRs the day they release and confirm your cohort assignment. A cohort error changes every benchmark you are measured against.
• File a recalculation request inside 15 days if anything looks wrong — it is also the only way to preserve the reconsideration right.
• Read the measure-level detail, not the Total Performance Score. The TPS tells you the outcome; the measure rows tell you what to fix.
• Confirm you clear the five-measure minimum. Below it, you receive no TPS and no adjustment, which changes the strategy entirely.
• Weight your effort to Discharge Function Score first. At 15%, it moves the TPS more than the three new OASIS measures combined.
• Treat MSPB-PAC as a care-coordination measure, not a visit-volume one. It rewards readmission avoidance and downstream spending discipline.
• Model the CY 2028 adjustment into next year's budget now. CY 2026 performance is already three-quarters written.

The Bottom Line

HHVBP went from a pilot in nine states to a nationwide model with a plus-or-minus 5% per-claim swing, budget-neutral scoring, and a measure set where one OASIS item carries 15% of the score. The reports are in iQIES on a published calendar with short, hard windows. The two-year lag means the agencies reading those reports this month are the ones who will control their CY 2028 payment. If you want help translating your Total Performance Score into a revenue forecast, schedule a free consultation.

Sources

• CMS, Expanded Home Health Value-Based Purchasing Model
• CMS, Expanded HHVBP Model Guide, December 2025 — payment adjustment range, budget neutrality, report timing, appeals
• CMS, CY 2026 Measures and Reports At-A-Glance — measure set, weights, baseline years
• CMS, Expanded HHVBP Model June 2026 Newsletter — CY 2026 report dissemination dates, iQIES risk-adjustment correction, claims-measure updates
• CMS, CY 2026 Home Health PPS Final Rule Fact Sheet (CMS-1828-F), November 28, 2025 — CY 2026 measure additions, removals, and reweighting
• CMS, CY 2027 Home Health PPS Proposed Rule Fact Sheet (CMS-1844-P), July 1, 2026 — no HHVBP-specific policy changes proposed

Last updated: September 2026.

Soriaga & Associates, LLC is a CPA firm with 25+ years of home health and hospice accounting experience. Ask about our bookkeeping services for Medicare-certified agencies.