As we reflect on 2025, Amity Healthcare Group would like to express our sincerest appreciation for the trust you have placed in us in the past year. We appreciate your loyalty and look forward to moving into the New Year together.
We wish you an incredibly Happy Holiday season and a peaceful and prosperous New Year!
Amity Healthcare Group Team
We took a short break from our newsletters, but we’re excited to return with important updates, resources, and industry insights. Meanwhile, we’ve been hard at work on several major initiatives and are pleased to share a few highlights.
This week we have the following sections covered under this newsletter.
We are proud to announce our partnership with Axxess. Through Axxess Training and Certification+, we are collaborating to deliver high-quality education that strengthens clinical confidence, supports compliance, and improves patient outcomes for home health organizations nationwide.
Please visit the full Partnership Announcement.
We have also deepened our engagement with the Texas Association for Home Care & Hospice. Look for Amity Healthcare Group articles in the TAHC&H Perspective newsletter and announcements for upcoming educational webinars throughout 2026.
Continued Partnership with ACHCU
We’re proud to continue our partnership with ACHCU, the educational division of ACHC, for a free webinar Mastering the Documentation of Reasonable and Necessary Care in Home Health, on January 20th, 2026, at 12p ET.
Together, we’ll explore practical strategies to identify the skilled care needs that are reasonable and necessary and how to complete clinical documentation that clearly supports those needs. We will review CMS guidelines, highlight common pitfalls, and share real-world examples to help clinicians create documentation that supports the plan of care and medical necessity. Attendees will leave with actionable tips to enhance documentation consistency and compliance
More updates are on the way – we’re excited to continue supporting your success in the year ahead!
On November 28, 2025, CMS issued the Final CY 2026 Home Health Rule (final rule) along with an accompanying fact sheet.
Following significant advocacy efforts from the National Alliance for Care at Home and other advocacy organizations, home health providers and industry organizations, CMS took into account some of the home health community’s recommended changes in its final rule and reduced the originally proposed payment cuts.
Let’s review at the key provisions of the rule.
Payment Updates
- Finalizes CY 2026 payment rates.
- Overall payment change: – 1.3% ($220M decrease) vs. the proposed –6.4% ($1.135B decrease).
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- Expands who may perform the encounter.
- Physicians, NPs, CNSs, and PAs may conduct the F2F encounter regardless of whether they certify the plan of care or cared for the patient in the referring facility.
Note: Please remember that the intent remains for the F2F encounter to be completed by the practitioner most familiar with the patient’s condition.
- CoP and OASIS Terminology Alignment
- The term “beneficiary” will be replaced with the term “patient” in §484.45 Condition of participation: Reporting OASIS information and in § 484.55-Condition of Participation: Comprehensive assessment of patients
- Home Health Quality Reporting Program (HHQRP)
CMS finalizes removal of:
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- COVID-19 Vaccine: Percentage of Patients Up to Date measure (OASIS item required until April 1, 2026).
- Four standardized assessment items:
- Living Situation (1)
- Food items (2)
- Utilities (1)
- Changes to HHQRP Reconsideration process for non-compliance with HHQRP
- HHAs that failed to provide complete, timely data to CMS may submit request for reconsideration for non-compliance if they can show full compliance
- HHAs may request an extension to submit a reconsideration request for extraordinary circumstances (e.g., natural disasters, cyberattacks).
- Requests due within 30 days of the notice of non-compliance.
- HHCAHPS Survey Updates (Effective April 2026)
Key changes include:
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- Adding 3 new patient-experience questions (health self-management, family instruction, staff caring).
- Reducing medication items from 6 to 2.
- Removing unused or low-performing questions.
- Introducing revised composites and 3 standalone measures.
Note: Although updates to the HHCAHPS survey is welcome, please remember that these updates will affect Star Ratings and HHVBP.
- HHVBP: New Measures
- Medicare Spending per Beneficiary (claims-based)
- Improvement in Bathing; Improvement in Dressing Upper/Lower Body
- CMS will release benchmarks/thresholds in Oct. 2025 IPRs.
- Removes 3 HHCAHPS survey-based measures due to HHCAHPS survey revisions:
- Care of Patients
- Communication
- Specific Care Issues
- Provider Enrollment Changes
- Expanded retroactive revocation authority when noncompliance predates the revocation notice. Certain Medicare enrollment revocations become effective prospectively – specifically, 30 days after the date that CMS or the CMS contractor mails notice of the revocation to the affected provider or supplier (hereafter “provider”). However, there are several grounds for which CMS can revoke a provider’s enrollment retroactively to the date the provider’s noncompliance began.
- New bases for revocation or deactivation, including:
- Abuse of billing privileges (claims for services not furnished).
- Deactivation of physicians/practitioners who have not ordered/certified/referred services for 12 consecutive months (privileges reinstated upon updated information).
Meet Access IQ – a technology platform designed to prevent Medicaid disenrollment and keep HCBS eligibility stable. Access IQ automates eligibility and renewals, reduces churn, eliminates paperwork errors, and integrates with state, MCO, and provider systems for real-time eligibility insight.
Message From the Founders:
Medicaid changes will significantly strain the system:
- Federal: 6-month renewals, 80-hour work requirements
- State: Budget cuts and shifting policies
- Local: County offices understaffed by 40%
This increases the risk of coverage loss for patients and heavier workloads for agencies. Each disenrollment can cost agencies $40K–$80K in lost revenue – often due to system failures, not ineligibility.
Access IQ = Prevention, Not Panic
Access IQ monitors policy changes and flags at-risk patients 30–60–90 days before disenrollment, identifying missing documents, work-requirement issues, and other gaps early. Your team can intervene proactively to protect both coverage and revenue.
Interested in a pilot?
Email info@accessiq.health or Schedule a Demo. Please also visit Access IQ at www.accessiq.health.
Beginning January 2026, the following updates will apply to Pend and Prior Authorization Request (PAR) timeframes:
- Pend timeframe reduced: Responses to pends must be submitted within 7 calendar days (previously 10 business days).
- No extensions for additional pends: All information requested in the initial pend must be submitted. Missing documentation will result in technical denial.
- Expedited PARs: No pends or requests for additional information will be allowed to meet the 3-day expedited decision requirement. Ensure full documentation is included with the initial submission.
According to HCPF, these changes align with Interoperability Turnaround Time Requirements and are intended to improve overall PAR processing times and reduce administrative burden.
Beginning in 2025, all long-term care employers must report total hours worked by each eligible direct care worker for the calendar year.
Who Must Report:
- Employers providing HCBS, nursing facility services, and certified home care agency services. (This rule will impact your organization if you are a Class A provider agency that is also certified for Medicaid Waivers (Personal Care or IHSS) or you are a class B provider)
Eligible Workers:
Direct care workers (excluding CNAs) who:
- Provide hands-on personal care or services to long-term care recipients, and
- Work at least 720 hours during the tax year.
Reporting Deadline:
- Reports are due to the Department of Revenue by January 31 of the following year.
- Example: 2025 hours → due January 31, 2026
- A $500 penalty may apply for late filing.
What to Report:
- Worker’s name
- SSN or ITIN
- Total hours worked during the calendar year
HCPF will send awareness communication to affected providers.
Additional Resources:
- HB24-1312
- Department of Revenue Long Term Care Employer Report Info
- Direct Care Worker Tax Credit FAQ
Questions can be forwarded to – HCPF_DCWorkforce@state.co.us
Texas News
Beginning in early 2026, HHSC will launch the State of Texas Electronic Provider System (STEPS), replacing STAIRS. STEPS will streamline Medicaid and non-Medicaid cost reports, Supplemental and Directed Payment Program enrollments, and required legislative reporting. STAIRS will remain active until the transition is complete.
STEPS Resources:
- STEPS webpage: Central hub for updates and announcements.
- FAQ at STEPS webpage: Updated regularly based on provider questions.
- Transition Guides at STEPS webpage: Updated Dec. 1 with access, training, and system details.
- Cost Report Webpages (PFD Cost Report Information and PFD Cost Report Training): Updated with STEPS-related training and cycle information.
Amity’s newsletters will be archived on Amity’s Healthcare Group website at https://amityhealthcaregroup.com/resources/ under Resources / Our Newsletter section.
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Thank you,
Irina Gorovaya, RN BSN, MBA
Amity Healthcare Group, LLC
Home Health Consulting, Education and Outsourcing Services
713-564-5011 (Houston Office), 303-690-2749 (Denver Office), 720-398-6200 (fax)
https://amityhealthcaregroup.com/
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Amity Healthcare Group
Houston Office
1201 Fannin Street, Suite 262,
Houston, Texas 77002
Denver Office
12835 East Arapahoe Road, Tower II, Suite 320,
Centennial, CO 80112
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