HHCAHPS Changes Incoming….

The home health industry is preparing for a significant update to the HHCAHPS survey that will take effect on April 1. This is a big deal — the HHCAHPS survey has remained largely unchanged since its introduction, and these upcoming revisions represent a true overhaul rather than a minor refresh.

What’s Being Removed?

Several existing questions will be eliminated as part of the update:

• Four of the six medication-related questions will be completely removed
   
• Three questions asking patients whether they received nursing services, therapy services, or similar care will be eliminated
   
• Another question — asking whether staff discussed the services patients would receive at the start of care — is also being removed after showing poor performance
   

Altogether, this means a substantial reduction in the number of questions agencies have been using to monitor for years.

What’s Being Added?

With the removal of these items, three new questions will be introduced — each with a noticeably different focus.

One of the most impactful additions will be Question #11, which asks whether the patient felt the agency cared about them as a person. This question could be a game-changer. By the time patients reach this point in the survey, their emotional experience with the agency may strongly influence how they respond not only to this question, but to those that follow. If care felt rushed, impersonal, or task-focused rather than patient-centered, it could affect the overall tone of their responses.

Another new question, Question #12, asks whether family members or caregivers were given enough information to care for the patient in the agency’s absence, to the extent the patient wanted. This distinction is critical. Agencies will need to be thoughtful about identifying who is involved in the patient’s care, whether that individual is typically part of the care routine, and whether the patient has given permission (when cognitively able) to share health information. The emphasis here is not just on education, but on respecting patient preferences regarding how much information is shared and with whom.

How This Affects Outcome Measures and HHVBP

As these changes roll out, agencies should expect questions about how outcomes will be calculated moving forward. A crosswalk will be used to reflect how the revised survey impacts performance measures.

For example, under the Value-Based Purchasing (VBP) Model, there were five HHCAHPS-related measures in 2025. With the revised survey, that number will drop to two, since many of the questions previously tied to VBP scoring are being removed.

Similarly, HHCAHPS Star Ratings and outcome measures will be updated to align with the new survey structure, accounting for both the eliminated and newly added questions.

Talk With Your HHCAHPS Vendor — Now

Before April 1 arrives, agencies should plan to meet with their HHCAHPS vendor to confirm they are fully prepared to administer the updated survey and can support your organization throughout 2026. This is not a change you want to navigate at the last minute.

What About an Email Survey Option?

One of the most frequently asked questions during the Proposed and Final Rule process was whether HHCAHPS would allow an email version of the survey, similar to the one approved for hospice.

The answer is no.

In the Final Rule, CMS specifically addressed this issue, noting that email distribution was tested and resulted in poor outcomes. As a result, HHCAHPS surveys will not be distributed by email at this time.

That said, if you strongly believe an email option would improve patient engagement and response rates, it’s important to share that feedback. The HHCAHPS website includes an email address for submitting comments and questions, and agencies are encouraged to use it to voice concerns or suggestions directly to CMS.

What This Means for Your Agency

These HHCAHPS changes are more than a survey update — they signal a shift in what CMS is measuring and valuing in the home health patient experience.

First, agencies will need to rethink how they approach patient experience operationally. With fewer task-based and service-confirmation questions, the revised survey places greater emphasis on how patients feel about their care. The new question asking whether patients felt cared for as a person underscores the importance of relationship-based, patient-centered care. Clinical excellence alone will not be enough if patients perceive care as rushed, impersonal, or purely checklist-driven.

Second, communication with patients and families will matter more than ever. The new caregiver-focused question requires agencies to be intentional about identifying who is involved in the patient’s care, clarifying the patient’s wishes regarding information sharing, and ensuring education is both adequate and appropriate. This may require adjustments to admission workflows, care planning discussions, and documentation practices.

Third, agencies should expect changes in how performance is measured and reported. With fewer HHCAHPS measures tied to Value-Based Purchasing and updated Star Rating calculations, agencies will need to monitor how these shifts affect overall scores and reimbursement over time. While fewer measures may sound like a relief, the remaining questions carry significant weight and will require focused attention.

Finally, education and preparation are critical. Staff should be trained not only on what questions have changed, but on why they have changed and how everyday interactions — tone, communication, follow-through, and patient engagement — directly influence survey outcomes. This is an opportunity to align clinical care, documentation, and patient experience under a more holistic approach.

Agencies that proactively adapt their workflows, reinforce patient-centered practices, and partner closely with their HHCAHPS vendor will be best positioned to succeed as these changes take effect.