CMS Releases CY 2026 Home Health Payment Proposed Rule
On July 2, the Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2026 Medicare Home Health Prospective Payment System (HH PPS) proposed rule. Among other changes, CMS’ proposed payment updates would result in a 6.4%, or $1.135 billion, decrease to home health (HH) agency payments compared to CY 2025. This includes a proposed permanent behavior decrease of 3.7%, a temporary adjustment of -4.6% to recoup retrospective overpayments, and an estimated 0.5% decrease reflecting the effects of a proposed update to the fixed-dollar loss ratio.

CMS also proposed removing the COVID-19 Vaccine: Percentage of Patients Who Are Up to Date measure from the HH Quality Reporting Program (QRP) and the corresponding data element from the Outcome and Assessment Information Set (OASIS). There are also proposed changes for the HH Value-Based Purchasing (VBP) Model, including the removal of three measures: Care of Patients, Communications Between Providers and Patients, and Specific Care Issues. CMS also proposed removing four standardized patient assessment data elements from the CY 2025 HH QRP under the social determinants of health category, including one item for Living Situation, two items for Food, and one item for Utilities. CMS stated they are proposing the removal of these elements because they believe collecting them is too burdensome, but indicated they would consider reintroducing these concepts as part of a low burden interoperable electronic system.

Finally, CMS is proposing several policies meant to prevent fraud, waste and abuse. These policies are focused on Medicare provider enrollment and Durable Medical Equipment, Prosthetic Devices, Prosthetics, Orthotics, and Supplies (DMEPOS) accreditation.

IHA will prepare facility-specific estimated financial impact reports in the coming weeks. A CMS fact sheet outlining the CY HH PPS proposed rule is here. Comments on this proposed rule are due Sept. 2 and can be submitted through the Federal Register website.

Staff contact: Cassie Yarbrough

CMS Releases CY 2026 ESRD Proposed Rule
On July 2, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2026 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule. CMS proposed a CY 2026 base rate of $281.06, an increase of $7.24 compared to the CY 2025 base rate. CMS also proposed updates to its outlier policy. For pediatric beneficiaries, CMS proposed a decrease to the fixed dollar loss (FDL) amount from $234.26 to $148.34 and a decrease to the Medicare allowable payment (MAP) from $59.60 to $44.10. For adult beneficiaries, CMS proposed a decrease to the FDL from $45.41 to $12.11, and a decrease to the MAP amount from $31.02 to $22.09.

CMS also proposed removing measures from the ESRD Quality Improvement Program, including: Facility Commitment to Health Equity, Screening for Social Drivers of Health, and Screen Positive Rate for Social Drivers of Health. This is consistent with similar proposed measure removals across the Medicare fiscal year proposed payment rules.

A CMS fact sheet outlining the CY 2026 ESDR PPS proposed rule is here. Comments on the proposed rule are due Aug. 29 and can be submitted through the Federal Register website.

Staff contact: Cassie Yarbrough

Application Period for Managed Care Community Network Certification
A new application is available on the Illinois Dept. of Healthcare and Family Services (HFS) website for entities seeking certification as a Managed Care Community Network (MCCN). The application document includes requirements and MCCN eligibility criteria and standards that was recently sent to Medicaid enrolled hospitals in Cook County. Applications will be accepted until 11:59 CT on Aug. 4. Questions regarding this application should be directed to HFS.MCCN.Certification@Illinois.gov.  

Cybersecurity Vulnerabilities with Contec, Epsimed Patient Monitors 
The Food and Drug Administration (FDA) has updated the “Cybersecurity Vulnerabilities with Certain Patient Monitors from Contec and Epsimed: FDA Safety Communication” with information regarding a software patch to fix related cybersecurity vulnerabilities. The patch fully removes networking functionality from the devices, making them only usable for local monitoring—when vital signs are only observable in the physical presence of the patient. 

The Cybersecurity and Infrastructure Security Agency and FDA in January announced they discovered the monitors could be remotely controlled by an unauthorized user or not work as intended. The software also had a backdoor, potentially compromising networks the monitors may have been connected to. 

Notably, the Safety Communication advises that patients, caregivers and healthcare providers should not install the software patch, saying the installation requires specialized expertise. Healthcare facility staff, including information technology (IT) and cybersecurity staff, should reach out to Contec at contact@ContecMed.com for the software patch and installation instructions. Further recommendations for healthcare providers and healthcare facility staff, including IT and cybersecurity staff, can be found in the FDA communication.