MassHealth has proposed a set of regulatory changes affecting home health agencies in Massachusetts, including updates to program rules and payment structures, while leaving reimbursement rates unchanged.

The proposals, released late Friday afternoon, include revisions to 101 CMR 403, which governs the MassHealth home health program, and 101 CMR 350, which establishes payment rates for home health services. A public hearing is scheduled for April 3 from 2 to 4 p.m., with the regulations slated to take effect August 1, 2026 if adopted.

The most notable element of the proposal is what it does not do: raise rates.

MassHealth proposes to maintain current reimbursement levels for home health services. The decision reflects broader fiscal pressures facing the state. The Healey administration has signaled that slowing tax revenue and uncertainty around federal Medicaid funding will constrain spending in the upcoming fiscal year. Medicaid, known as MassHealth in Massachusetts, is one of the largest components of the state budget, covering roughly two million residents.

For home health agencies, however, the rate freeze comes as providers continue to grapple with rising labor costs, persistent workforce shortages, and growing clinical complexity among patients receiving care at home.

Home-based care has increasingly been viewed by policymakers as a cost-effective alternative to hospital and institutional care, particularly as Massachusetts confronts the needs of an aging population. But industry leaders have warned that reimbursement levels have not kept pace with the cost of delivering skilled nursing and therapy services in patients’ homes.

Alongside the rate decision, MassHealth is moving forward with a Value Based Payment (VBP) pilot program for home health agencies. The program would shift certain services away from the traditional fee-for-service model and instead reimburse participating agencies on a per-member-per-month basis.

Under the proposed structure, agencies would be eligible for two payment levels depending on performance against specified quality and outcome measures. The pilot reflects a broader shift within Medicaid and Medicare programs nationwide toward payment models that reward patient outcomes rather than service volume.

The proposed regulations also include several operational changes to the MassHealth home health program.

MassHealth plans to eliminate the “Statement of Fiscal Soundness” requirement, a financial documentation requirement historically used in the provider enrollment process.

The proposal would also clarify that initial patient assessments may be completed by therapists — including physical therapists, occupational therapists, or speech-language pathologists — when therapy services are the only services ordered by the physician or practitioner.

Another change addresses the definition of a Medication Administration Visit. Current language requires medication administration to be the sole purpose of the visit. The proposed revision would allow medication administration to be the primary focus, potentially providing clinicians greater flexibility to address other patient needs during the same visit.

State officials say the proposed updates are intended to modernize the program and align it with evolving models of home-based care delivery.

Provider groups are reviewing the proposal closely and are expected to submit comments before the regulatory hearing. Home health agencies, patient advocates, and other stakeholders will have the opportunity to provide testimony at the April hearing or submit written comments during the public review period.

The outcome of the process will help shape how home health services are delivered — and financed — for MassHealth patients in the years ahead.