HHVBP CY2026: OASIS measure weight bumped to 40%, MSPB-PAC introduced

The expanded HHVBP model has been live nationally since 2023, but CMS rewrote the Total Performance Score for the CY2026 performance year (which impacts CY2028 payment). The structural change is substantial enough that "we did fine in CY2025" doesn't carry forward.

What changed

• OASIS measure weight bumped to 40% of TPS (was lower) — and three new OASIS-derived measures join: bathing improvement, upper-body dressing improvement, lower-body dressing improvement.
• Three HHCAHPS measures dropped from the patient experience portion. The remaining two are weighted higher.
• MSPB-PAC introduced — Medicare Spending Per Beneficiary, Post-Acute Care. This is a claims-based measure that captures total Medicare spend on your patients through 90 days post-treatment.

What MSPB-PAC actually means

This is the change that should get the most attention. MSPB-PAC means CMS is now financially evaluating your agency on what happens to your patient after they're discharged from your care — specifically Medicare spending in SNFs, inpatient readmissions, hospital outpatient services, and other Part B claims.

Care coordination with hospitals and SNFs is no longer a goodwill exercise. It's a P&L item. If your patients have a higher-than-benchmark rehospitalization rate or get bounced into expensive SNF stays right after your care ends, MSPB-PAC pulls down your TPS — and your Medicare payment two years later.

What the OASIS bump means

OASIS measures are now 40% of how CMS evaluates you for value-based payment. The three new measures (bathing, upper-body dressing, lower-body dressing improvement) are all in the M1810/M1820/M1830 range — items clinicians complete on every assessment. The data is already there.

What changes: the discharge-to-discharge improvement on those items now drives a meaningful part of your VBP score. Agencies that have been treating OASIS scoring as a documentation chore (rather than a true clinical-outcome measurement) will see their TPS suffer.

The HHCAHPS contraction

Dropping three of five HHCAHPS measures simplifies the patient-experience scoring but also means individual survey responses now carry more weight. Agencies with low survey response rates are more vulnerable to outlier responses skewing the average.

What an agency should actually do

1. Pull your CY2025 OASIS-driven measures for bathing, upper-body dressing, lower-body dressing — at admission vs discharge. If you don't have a sense of where you stand, you're guessing on 40% of your VBP score.
2. Build relationships with the discharging hospitals and accepting SNFs in your service area. MSPB-PAC will reward agencies that have the warm transition lanes that keep patients out of expensive downstream care.
3. Prioritize HHCAHPS response rate over individual survey gaming. With fewer measures, response rate stability matters more.
4. Confirm your platform exposes per-patient OASIS deltas across the bathing/dressing items. You need to see a patient trending wrong on these well before discharge — not on the post-discharge audit.

What we built for this

Carelytic's clinical engine surfaces OASIS deltas (admission vs current vs projected discharge) on every patient's chart. The dashboards roll up to per-clinician and per-agency views so you can see if a clinician's caseload is consistently regressing on bathing/dressing — that's a training signal, not just a reporting line.

The bigger shift is mindset. HHVBP CY2026 makes home health responsible for the patient's broader Medicare trajectory in a way the model didn't before. The agencies that treat MSPB-PAC as a coordination problem (not a measurement problem) will be the ones with positive value-based adjustments in CY2028.