CMS Finalizes CY 2026 Medicare Home Health Payment Rule
On Nov. 28, the Centers for Medicare & Medicaid Services (CMS) finalized the calendar year (CY) 2026 Medicare Home Health Prospective Payment System (HH PPS) payment rule. CMS finalized an estimated 1.3% decrease to HH agency (HHA) Medicare payments for CY 2026, resulting in a $220 million decrease compared to CY 2025 payments. The final rate includes a permanent offset of -0.9% and a temporary adjustment of -2.7% to account for provider behavioral changes impacting aggregate expenditures due to the CY 2020 implementation of the Patient-Driven Groupings Model and 30-day unit of payment. 

CMS finalized changes to its face-to-face encounter policy, allowing physicians to join nurse practitioners, certified nurse specialists, and physician assistants in ordering and certifying patients for eligibility under the Medicare HH benefit and establish a plan of care. These providers may perform face-to-face encounters regardless of whether they are the certifying practitioner or whether they cared for the patient in the facility from which the patient was directly admitted to HH and who is different from the certifying practitioner.

CMS also finalized several new and revised provider enrollment provisions to strengthen its efforts to prevent fraud, waste and abuse. These include increasing the number of grounds for which CMS can revoke a provider’s Medicare enrollment retroactively and adding bases for revocation or deactivation of a provider’s Medicare billing privileges. Similarly, CMS increased the frequency of surveys and reaccreditations for Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, & Supplies (DMEPOS) suppliers, and implemented stricter requirements for becoming and remaining a DMEPOS accrediting organization. These changes were accompanied by changes to the DMEPOS prior authorization process and improvements to the DMEPOS competitive bidding program. 

Finally, CMS made several changes to the measures under the HH quality reporting program, including the removal of COVID-19 and social determinants of health measures, and expanded the HH Value-Based Purchasing Model.

A CMS fact sheet with more details on the final rule is here. IHA will make facility-specific estimated impact reports available to HH facilities via the IHA C-Suite in the coming weeks.

Staff contact: Cassie Yarbrough

Healing Communities: Wabash General Hospital's Free Foot Care Clinic
Healthy feet are essential to daily life and, with age, become even more crucial to staying mobile, active and safe. Wabash General Hospital in Mount Carmel promotes foot health in the community through its annual Free Foot Care Clinic. This year's three-day clinic provided 220 individuals with foot washing, toenail trimming and personalized referrals for additional care—key components of foot care all at no cost.

The hospital noted that the event offers “compassionate care and essential support to community members in need." Those participating in the clinic also walked away with a new pair of high-quality shoes and a pair of socks, made possible by donations from the Wabash General Hospital Foundation and hospital employees.

“In an inspiring show of support, Wabash General Hospital employees themselves contributed over $9,000 toward this year's effort—a true testament to their commitment to patients, not only through their time and expertise, but also through financial generosity," the hospital said.

The hospital partners with Ultimate Fit, a local shoe store, to ensure every clinic participant receives shoes from top-tier brands, offering not just comfort, but dignity and long-lasting support. With continued support and growing community involvement, the Free Foot Care Clinic is poised to serve even more individuals in the years to come.

IHA's Healing Communities: Hospital Stories webpage features the good work of hospitals across Illinois. Submit your hospital's or health system's story to Valerie Culver, Assistant Vice Presidents, Corporate Communications and Marketing, at vculver@team-iha.org.

IHA's Healing Communities campaign focuses on four pillars representing the positive impact of hospitals and health systems beyond care provided in the hospital setting. The pillars are: driving local economies, addressing community needs, providing accessible care and training future clinicians. 

Gov. Signs Immunization Legislation into Law
Yesterday, the Pritzker Administration announced that Gov. JB Pritzker has signed into law HB 767, legislation to strengthen the Illinois Dept. of Public Health’s (IDPH) ability to support access to immunizations deemed safe and effective. The legislation establishes the State Guidelines for Communicable Disease Prevention under the Communicable Disease Prevention Act. These guidelines, developed based on recommendations from the Immunization Advisory Committee and approved by the IDPH Director, will provide guidance on the general use of immunizations or medical countermeasures, as well as special situations or populations that may warrant modifications to routine recommendations.

Additionally, the Insurance Code is amended to require that insurance coverage, including appropriate cost-sharing, is extended to vaccinations that receive approved recommendations from the Immunization Advisory Committee.

Register: 2025 Award for Excellence in Telehealth
Illinois’ telehealth champions will be recognized during a virtual ceremony on Dec. 9, hosted by the Connected Health Initiative and the Partnership for a Connected Illinois. This event will celebrate the individuals and organizations working to expand access to high-quality, technology-enabled care across the state.

The Illinois Health and Hospital Association’s Senior Vice President and General Counsel, Karen Harris, will provide introductory remarks and present U.S. Senator Dick Durbin, who will receive special recognition for his leadership in advancing telehealth services and securing grant opportunities that help Illinois providers better serve patients. Sen. Durbin has championed hospital telehealth funding, supported the continuation of Medicare telehealth waiver flexibilities following the end of the Public Health Emergency in May 2023, and took leadership on activities of direct-to-consumer telehealth companies and their relationships with drug companies. Click here to register. 

The Infectious Respiratory Disease Surveillance Dashboard from the Illinois Dept. of Public Health (IDPH) provides the latest data on hospital visits, seasonal trends, lab test positivity and demographic data. IDPH also tracks COVID-19, influenza and respiratory syncytial virus information through the Illinois Wastewater Surveillance System dashboard.

Briefly Noted

Leading the News

A 5-step plan to embed pharmacy into health system strategy

Becker’s Hospital Review

For some hospitals and systems, pharmacy is the No. 1 revenue generator, but pharmacy department leaders say they’re often underutilized. 

This highly contagious "winter vomiting disease" is surging across the country

AXIOS
A norovirus that causes extreme vomiting is on the rise again. The highly contagious norovirus has arrived weeks ahead of expectations, per the CDC.

OSF HealthCare to launch digital health kiosks

Becker’s Hospital Review

Peoria, Ill.-based OSF HealthCare plans to roll out digital health kiosks to boost rural healthcare access. The 17-hospital system is partnering with Champaign, Ill.-based University of Illinois Gies College of Business and IT company Tata Elxsi on the kiosks, which will run on Amazon Web Services cloud infrastructure and feature EHR integration and telehealth services.

Rochelle Community Hospital expands behavioral health services

WIFR

Shrinking wait times and expanding care for those in need of mental health help, Rochelle Community Hospital celebrates the opening of its new Behavioral Health Services clinic.