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

Oversight Matters

Every Medicare‑certified Home Health Agency (HHA) operates under the supervision of the Centers for Medicare & Medicaid Services (CMS). This oversight ensures that agencies deliver safe, high‑quality care, follow federal regulations, and maintain accurate reporting. CMS oversight affects:

• Quality Measure performance
• Star Ratings
• Home Health Value-Based Purchasing (HHVBP) payment adjustments  HHVBP Tip Sheet
• Public reputation
• Survey outcomes
• Compliance risk

Understanding how CMS evaluates home health helps patients make informed choices and helps agency owners stay compliant and competitive.

Section 1 – Quality Measures HHAs Must Report

CMS requires HHAs to submit several categories of quality data. These measures reflect patient outcomes, safety, and clinical effectiveness.

A. OASIS‑Based Quality Measures

These measures come directly from the OASIS‑E2 assessment completed at Start of Care, Resumption of Care, Recertification, and Discharge. CMS uses these standardized data points to evaluate functional improvement, safety, and clinical outcomes — and they also play a direct role in how agencies are reimbursed under the Patient‑Driven Groupings Model (PDGM).

Examples include:

• Improvement in ambulation
• Improvement in bathing
• Improvement in medication management
• Discharge to community
• Acute care hospitalization
• Emergency department use

These measures reflect functional improvement, safety, and clinical outcomes based on standardized OASIS data.

B. Claims‑Based Measures

These measures are calculated from Medicare claims, not OASIS. The Home Health Value‑Based Purchasing (HHVBP) Model uses quality measures and patient experience surveys to evaluate how effectively an agency delivers care.

Examples include:

• Hospitalization during home health
• ED use without hospitalization
• Total cost of care

Claims‑based measures help CMS evaluate how well agencies prevent avoidable hospital use.

C. Reporting Requirements

Agencies submit quality data and CMS uses this information to:

• Calculate Quality Star Ratings
• Calculate Patient Survey Star Ratings
• Score agencies under HHVBP HHVBP Tip Sheet
• Display results on Care Compare

Accurate OASIS and strong clinical outcomes directly impact reimbursement and public ratings.

II. Consumer Surveys (HHCAHPS)

HHCAHPS is the Home Health Consumer Assessment of Healthcare Providers and Systems — CMS’s patient satisfaction survey.

A. What HHCAHPS Measures

Patients rate their experience with:

• Communication
• Professionalism
• Care coordination
• Patient education
• Overall satisfaction

These scores reflect how patients feel about the care they receive.

B. Who Must Participate

Agencies with 60 or more eligible patients per year must participate. HHAs must contract with an approved HHCAHPS vendor to administer the survey.

C. Why HHCAHPS Matters

HHCAHPS scores:

• Drive Patient Survey Star Ratings
• Influence HHVBP payment adjustments
• Appear on Care Compare
• Affect referrals and reputation

Strong communication and patient education are key to improving HHCAHPS performance.

Care Compare (Public Reporting)

CMS’s Care Compare website displays quality and performance information for every Medicare‑certified HHA.

A. What Appears on Care Compare

• Agency name & location
• Quality Star Ratings
• HHVBP performance
• Hospitalization rates
• ED use

This information is updated regularly and is available to the public.

B. Why Care Compare Matters

Care Compare influences:

• Consumer choice
• Hospital and physician referrals
• Competitive positioning
• Acquisition interest
• Agency reputation

Owners often use Care Compare to benchmark themselves against competitors.

C. How Agencies Can Improve Their Public Profile

• Accurate OASIS
• Strong HHCAHPS scores
• Reduced hospitalizations
• Strong QAPI program
• Consistent staff education
• Effective care coordination

Public ratings reflect both clinical performance and patient experience.

V. How CMS Oversight Connects to PDGM, HHVBP, and OASIS

A. PDGM

• OASIS accuracy affects functional scoring
• Diagnoses must match documentation
• Hospitalization rates influence cost measures

B. HHVBP

HHVBP adjusts payments based on:   Addl HHVBP Tip Sheet

• Quality measures
• HHCAHPS scores
• Claims‑based outcomes
• OASIS accuracy

C. OASIS

OASIS is the foundation of:

• Quality reporting
• Star Ratings
• HHVBP scoring
• Care Compare outcomes

Accurate OASIS documentation is essential for compliance and reimbursement.

VI. Resources for Home Health Agency Owners

These tools help agencies stay compliant, competitive, and survey‑ready.

• Medicare HHA Owners Database — 2026 Edition (Gumroad)
• HHVBP Tip and Information Sheet (Payhip)
• HHCAHPS Additional Tips and Information (Gumroad)

Disclaimer

This article is for educational purposes only and not medical advice. Please consult a healthcare professional for any medical concerns.  This article may contain links to products where there may be a charge for the information.

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About the Author — Rhonda McElvany, RN, CRC, with over 30 years of experience in hospital inpatient, outpatient, data validation, and risk-adjustment coding, now enjoys writing about today’s healthcare issues and concerns.