HHVBP: What Every Home Health Agency Needs to Know in 2026

7/24/2026              Rhonda McElvany, RN, CRC                BHealthyRN.com

HHVBP isn’t new anymore — it went national in January 2023, and by now most agency leaders have at least heard the acronym. But here’s what I’m seeing in the field: a lot of agencies are still treating it like background noise. That’s a problem, because the 2026 updates mean if you aren’t actively managing your measures right now, you are already falling behind. And the money — up to a 5% bonus or a 5% penalty on your Medicare payments — is very, very real.

The Basics — What HHVBP Actually Does

Home Health Value-Based Purchasing is CMS’s way of tying a percentage of your Medicare payments directly to quality performance. Every Medicare-certified home health agency in the country is now participating — there is no opting out.

The model works on a two-year lag. How you perform in 2026 determines what you get paid in 2028. Your annual payment adjustment can range from a +5% bonus to a -5% penalty, benchmarked against both national peers and your state cohort.

HHVBP Tip and Additional Information Sheet

“Your CY 2026 performance determines your CY 2028 payment. That clock is already running.”

Payment adjustments aren’t a rounding error — they are a strategic financial reality. An agency billing $5 million annually in Medicare payments is looking at a $250,000 swing in either direction. That’s not abstract. That’s staff, equipment, and operating margin.

HHVBP is not a form or a separate submission. CMS calculates your HHVBP score automatically from your OASIS assessments, Medicare claims, and HHCAHPS surveys.

Your 2026 Score Card — What’s Being Measured

Your HHVBP score is built from three measure categories. The weights differ slightly depending on whether your agency falls into the larger-volume or smaller-volume cohort, but the categories are the same for everyone.

Measure Category — Larger Volume / Smaller Volume Weights

• OASIS-Based Outcome Measures — 40% / 50%
• Claims-Based Measures — 40% / 50%
• HHCAHPS Survey-Based Measures — 20% / 0%

OASIS-Based Measures (6 total)

• Improvement in Dyspnea — 7%
• Improvement in Management of Oral Medications — 11%
• Discharge Function Score — 15%
• Improvement in Bathing (M1830) — 3.5%
• Improvement in Upper Body Dressing (M1810) — 1.75%
• Improvement in Lower Body Dressing (M1820) — 1.75%

Claims-Based Measures

• Home Health Within-Stay Potentially Preventable Hospitalization (PPH) — 15%
• Discharge to Community – Post-Acute Care (DTC-PAC) — 15%
• Medicare Spending Per Beneficiary-PAC (MSPB-PAC) — 10%

HHCAHPS Survey Measures (larger-volume only)

• Overall Rating of Home Health Care — 10%
• Willingness to Recommend the Agency — 10%

Takeaway: OASIS-based outcomes carry the most weight and are the most controllable.

What Changed for 2026 — Read This Carefully

CMS made meaningful structural changes in the Final Rule:

• Three HHCAHPS survey-based measures were removed.
• Measure weights were adjusted.
• A new 9th measure removal factor was added.
• Smaller-volume agencies now have HHCAHPS weighted at 0%.

Payment Context You Need to Know

• CY 2026 market basket update: +2.4%
• Permanent behavioral adjustment: -1.023%
• Temporary base rate reduction: -3%
• Agencies failing to submit quality data only receive +0.4%

Baseline year for most measures: CY 2023 IPRs release quarterly: Jan, Apr, Jul, Oct Preview Annual Performance Report for CY 2025: August 2026

The OASIS Connection — Where Agencies Win or Lose

The six OASIS-based measures are driven by clinical care and documentation accuracy. Many agencies deliver excellent care but score poorly due to inconsistent OASIS coding.

Key Principle

One miscoded OASIS item can affect multiple HHVBP measures simultaneously.

M1810, M1820, and M1830 drive their own measures and feed into the Discharge Function Score (15% of your total score).

Accurate SOC and discharge coding is foundational. Overcoding or undercoding distorts your performance picture and affects your bonus potential.

3 Things To Do Right Now

1. Pull your current Interim Performance Report

IPRs release quarterly. If you haven’t checked yours recently, do it today.

2. Audit OASIS accuracy on M1810, M1820, M1830

These items directly drive three measures and feed the highest-weighted measure on your scorecard.

3. Track hospitalization rates actively

PPH is 15% of your score. CMS calculates it from claims, but you can track it internally in real time.

The Bottom Line

HHVBP rewards agencies that are disciplined about documentation and consistent in outcomes. Agencies earning bonuses aren’t doing anything magical — they’re doing the basics exceptionally well.

Start with your IPR. Know your numbers. Work backward to the OASIS items and hospitalization patterns that move your score.

The clock is already running on your 2028 payment — but you still have time to influence where you land.