When patient experience scores shift, agencies feel it quickly.
Star Ratings move. Value-Based Purchasing (HHVBP) results change. Referral sources ask questions. Leadership meetings suddenly focus on survey vendors, response rates, and whether front-line staff are actually influencing CAHPS performance.
Now, with Home Health CAHPS (HHCAHPS) changes taking effect in April 2026, many Medicare-certified home health agencies are asking the same question:
“What exactly is changing, and what do we need to do right now?”
*This article was written in consultation with Mariam Treystman.
At The Home Health Consultant (THHC), we work with Medicare-certified home health agencies nationwide on compliance infrastructure, quality oversight, and survey readiness.
We’re writing this article to clarify:
- what CMS has finalized for HHCAHPS beginning April 2026
- how it impacts Medicare certified providers
- how agencies can align operationally before these changes affect performance scores and public reporting
What Is Changing in the HHCAHPS Survey Beginning April 2026?
Beginning with surveys administered for April 2026 discharges and forward, CMS is implementing updates to the HHCAHPS survey instrument and administration protocols.
The changes stem from CMS rulemaking and technical updates intended to:
- Modernize survey content
- Improve clarity of patient experience measures
- Streamline administration
- Align public reporting with current quality priorities
For Medicare-certified home health agencies, the most important categories of change include:
- Revisions to CAHPS survey questions and response scales
- Updates to composite measures and public reporting groupings
- Technical specification updates affecting vendors and sampling
- Administrative protocol clarifications
While the overall structure of HHCAHPS remains intact, agencies should not assume this is a minor wording adjustment. Even subtle survey changes can significantly impact composite scores and Star Rating once publicly reported on Care Compare.
Transitioning to the specifics, let’s examine what agencies need to understand about the survey content itself.
Are the HHCAHPS Survey Questions Changing in 2026?
Yes. CMS has approved revisions to portions of the HHCAHPS instrument effective April 2026.
These updates include:
- Refinements to question wording for clarity
- Adjustments to response options in certain items
- Potential reorganization of question groupings
- Alignment with current patient-centered language standards
CMS periodically revises CAHPS instruments to improve reliability, reduce ambiguity, and enhance comparability across providers. These revisions are incorporated into updated HHCAHPS Protocols & Guidelines Manuals and Technical Specifications.
For agencies, the operational impact is not in rewriting the survey (vendors handle that), but in understanding that:
- Historical internal benchmarks may no longer trend identically
- Staff education may need adjustment
- Certain patient experience domains may weigh differently
This means agencies should not rely solely on historical performance patterns to predict post-2026 outcomes.
Which leads to the next concern.
Will the 2026 HHCAHPS Changes Affect Star Ratings and Public Reporting?
HHCAHPS results are publicly reported on Care Compare and contribute to patient experience Star Ratings.
So, this means that any changes to…
- Question wording
- Composite calculations
- Measure groupings
- Case-mix adjustment methodologies
…can influence Star Rating calculations over time.
Although CMS typically includes transition periods and technical guidance, agencies should anticipate:
- Temporary score variability during implementation
- Shifts in how certain domains perform relative to prior years
This is particularly relevant for agencies now that we’re under the Home Health Value-Based Purchasing (HHVBP) system. Under HHVBP, patient experience measures influence payment adjustments.
In short: the survey may look similar, but scoring dynamics may shift.
Do Agencies Need to Change Vendors or Contracts Because of the 2026 HHCAHPS Updates?
Not necessarily, however, your agency is responsible for confirming your vendor’s readiness.
Under Medicare requirements, certified home health agencies must use an approved HHCAHPS survey vendor and comply with CMS administration protocols.
Before April 2026, agencies should confirm in writing that their vendor:
- Has implemented the updated 2026 HHCAHPS instrument
- Is following the revised Protocols & Guidelines Manual
Agencies are ultimately responsible for compliance, even though vendors administer the survey.
Failing to align with updated CMS protocols could place an agency at risk for data rejection, public reporting delays, potential non-compliance findings.
What Is the February 27, 2026 HHCAHPS Vendor Submission Requirement?
On February 5, 2026, the HHCAHPS Survey Coordination Team announced that all approved vendors must submit revised survey materials for review and approval by February 27, 2026 as part of the April 2026 rollout.
This requirement applies to vendors only, so there’s no action required on your home health’s end, other than reaching out to your vendor to confirm compliance.
Are HHCAHPS Participation Requirements Changing for Medicare-Certified Agencies?
No, the fundamental requirements for HHCAHPS surveys remains:
Medicare-certified home health agencies must participate in HHCAHPS unless they qualify for a CMS-approved exemption (such as low monthly patient census thresholds).
There is no indication that CMS is eliminating participation requirements. Operationally, agencies cannot “pause” participation while adapting to the new version.
Meaning, agencies must ensure:
- Continuous monthly sampling
- Timely vendor submission
- Accurate patient eligibility identification
- Maintenance of documentation supporting compliance
Frequently Asked Questions About the 2026 HHCAHPS Changes
Q: Do we need to resubmit old data when the new survey starts?
A: No. The updated survey applies prospectively beginning with the April 2026 effective period.
Q: Will response rate requirements change?
A: Agencies must continue meeting CMS participation and sampling requirements. CMS has not indicated elimination of core response expectations.
Q: Can we administer our own supplemental survey?
A: Yes, agencies may conduct internal satisfaction surveys, but they cannot replace HHCAHPS participation or alter CMS-required processes. More on this below.
Q: Will the number of questions increase?
A: CMS updates typically aim to streamline and refine rather than significantly expand survey length.
What Should Agencies Be Doing Now to Prepare for April 2026?
Patient experience reporting will continue evolving. Compliance systems must evolve with it.
HHCAHPS changes in 2026 are not isolated events. They reflect CMS’s ongoing refinement of quality measurement.
Agencies that succeed long-term:
- Integrate HHCAHPS results into QAPI and PIPs
- Tie patient experience data to staff education coaching
- Review performance monthly
- Treat patient experience as a compliance function, not just a marketing metric
Understanding HHCAHPS requirements is one piece of the equation. Many agencies also ask how to conduct internal surveys separate from HHCAHPS. We address that in detail here:
If your leadership team is evaluating how to align compliance, public reporting, and internal quality monitoring, this article will help clarify where Medicare requirements end and internal strategy begins.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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