Short answer: In 2026, CMS publishes two home health star ratings on Care Compare: a Quality of Patient Care (QoPC) rating built from seven OASIS- and claims-based measures, and a Patient Survey rating built from HHCAHPS. CMS ranks agencies on each measure, combines the results, and assigns 1 to 5 stars in half-star steps, updated quarterly (CMS Star Ratings; CMS QoPC Methodology). Because six of the seven QoPC measures come from OASIS, accurate assessments are the most direct lever an agency has over its rating.
Every agency leader we talk to wants a better star rating. Fewer can name the measures behind it or the OASIS items that drive those measures. This guide covers both.
What are the two types of home health star ratings?
CMS publishes a Quality of Patient Care star rating, based on OASIS assessments and Medicare claims, and a Patient Survey star rating, based on the Home Health CAHPS (HHCAHPS) survey. Both are updated quarterly on Care Compare (CMS Home Health Star Ratings).
CMS first posted QoPC ratings in July 2015 and Patient Survey ratings in January 2016 (CMS). They measure different things. QoPC reflects clinical process and outcomes. The Patient Survey rating reflects how patients experienced your care.
Which 7 measures make up the Quality of Patient Care star rating?
The QoPC rating uses seven measures: Timely Initiation of Care, Improvement in Ambulation, Improvement in Bed Transferring, Improvement in Bathing, Improvement in Dyspnea (shortness of breath), Improvement in Management of Oral Medications, and Home Health Within-Stay Potentially Preventable Hospitalization (PPH) (CMS).
- Timely Initiation of Care is a process measure. It counts episodes where start or resumption of care happened on the physician-ordered date, or within two days of referral or inpatient discharge when no date was specified (CMS HH QRP Measure Calculations Manual v2.0).
- The five improvement measures compare OASIS responses at start or resumption of care with responses at the end of care.
- PPH is claims-based. CMS replaced the Acute Care Hospitalization measure with PPH in the star rating as of the October 2024 refresh (CMS QoPC Methodology, July 2024).
Who qualifies for a star rating?
Every Medicare-certified agency can receive a QoPC rating if it has enough data. A measure needs at least 20 complete quality episodes (or home health stays, for claims-based measures) to be reported, and an agency needs data for at least 5 of the 7 measures to receive a rating (CMS).
A completed quality episode pairs a start or resumption of care assessment with an end-of-care assessment (discharge, transfer, or death), and the episode must end within the reporting period (CMS). For larger agencies, eligibility is rarely the problem. Whether the data reflects your patients accurately is.
How does CMS turn measure scores into stars?
CMS compares each agency’s score on each measure with the national distribution, adjusts scores that aren’t statistically different from the middle, averages the results across measures, and converts that average into a rating from 1 to 5 stars in half-star increments (CMS QoPC Methodology).
Two practical takeaways:
- Your rating is relative. You’re compared with other agencies, so holding steady while others improve can lower your stars.
- Every measure counts. A consistently weak measure pulls the average down, even if others are strong.
Here’s how the steps work, per the current CMS methodology (CMS QoPC Methodology, July 2024):
- Deciles. For each of the 7 measures, CMS sorts all agencies’ scores and splits them into 10 roughly equal groups. Each decile gets an initial rating from 0.5 to 5.0 in half-star steps.
- Significance check. If your initial rating is anything other than 2.5 or 3 (the two middle groups) and your score is not statistically different from the national agency median (a binomial test with p > .05), your rating moves a half star toward the middle.
- Average and round. CMS averages your adjusted ratings across the measures and rounds to the nearest half star.
- Final star rating. That average maps to a final rating from 1 to 5 stars. An average of 2.5 becomes 3 stars, 4.5 or 5.0 becomes 5 stars, and 0.5 becomes 1 star.
Why does OASIS accuracy matter so much?
Six of the seven QoPC measures come from OASIS, and five of those compare start-of-care and end-of-care responses. If either end of the pair is scored inaccurately, the measure reflects documentation, not the care your clinicians delivered.
How errors show up:
- SOC scoring that understates limitations leaves less room to show real improvement.
- Discharge scoring that overstates improvement creates inconsistency with the clinical record and compliance risk.
- Inconsistent scoring across clinicians or branches turns your outcomes into noise rather than a signal you can manage.
- SOC/ROC dates that don’t match orders or referral documentation can hurt Timely Initiation of Care.
Since July 1, 2025, agencies must submit OASIS for all patients regardless of payer, though CMS still calculates OASIS-based measures only for Medicare FFS, Medicare Advantage, Medicaid, and Medicaid managed care patients (CMS). More assessments mean more chances for error.
Which OASIS items get corrected most often?
Across the agencies we support, these are the OASIS items our coders have changed most often in recent reviews, roughly in order:
- M1033 Risk for Hospitalization
- M1850 Transferring
- M2102 Supervision and Safety Assistance
- M1800 Grooming
- M1860 Ambulation/Locomotion
- M1810 Dressing Upper Body
- M1830 Bathing
- M2020 Management of Oral Medications
- M1845 Toileting Hygiene
- J0530 Pain Interference with Day-to-Day Activities
Six of the ten are functional ADL items, and several feed directly into star rating improvement measures such as Improvement in Bathing, Ambulation, Bed Transferring, and Management of Oral Medications. That’s where a second set of eyes on the start of care assessment pays off most.
When do ratings refresh, and what’s the reporting lag?
Care Compare refreshes quarterly, in January, April, July, and October. CMS posts Provider Preview Reports in iQIES about three months before each refresh, and its deadlines calendar lists a suppression/review request deadline for each refresh (CMS Data Submission Deadlines; CMS Star Ratings).
Preview reports for the January 2027 refresh became available in iQIES on September 30, 2026 (CMS HH QRP Spotlight). Ratings use a 12-month reporting period, and OASIS-based measures use data with a lag (CMS QoPC Methodology), so assessments you complete today affect ratings several quarters from now. CMS hasn’t announced an exact posting date for the January 2027 refresh. It announces each refresh on the Spotlight page when the data goes live. The October 2026 refresh, for example, posted on October 21, 2026 (CMS HH QRP Spotlight).
How should we use our Provider Preview Report?
Open it as soon as it’s available, compare it with the prior quarter, and trace any measure that moved back to the underlying assessments. The preview is your chance to prepare leadership and catch calculation errors before ratings post.
A practical review:
- Note every measure that moved, up or down.
- Break results down by branch and clinician where your systems allow it.
- Sample the episodes behind any measure that dropped, and compare SOC and discharge scoring with the clinical documentation.
- Separate data problems (fix with training and review) from care problems (need a clinical response).
- Brief your leadership and board before ratings go public.
Does the star rating connect to payment?
Not directly, but the same OASIS measures feed the expanded Home Health Value-Based Purchasing (HHVBP) Model, which adjusts Medicare payment based on performance. The CY2026 final rule changed the HHVBP measure set starting in CY2026. It added three OASIS-based bathing and dressing measures and the claims-based Medicare Spending Per Beneficiary measure, removed three HHCAHPS measures, and shifted weight toward OASIS and claims measures (CMS-1828-F fact sheet). The CY2027 final rule, placed on public inspection on November 4, 2026, makes no changes to the HHVBP Model (Federal Register document 2026-22750). For a plain-English rundown, listen to Home Health Revealed episode 138.
One accurate OASIS process protects both your public rating and your reimbursement.
How do we build an OASIS review process that improves accuracy?
Review the highest-impact time points (SOC, ROC, discharge) before submission when possible, give clinicians specific and timely feedback, and track which items change most often. A review without a feedback loop catches errors but rarely prevents the next one.
How we approach it at HealthRev: our certified coders and OASIS reviewers make the final call, and you choose the review level that fits your agency:
- Coding: selection of correct, physician-verified diagnoses, with severity ratings suggested where applicable.
- Coding Plus: coding and OASIS review focused on the M-items that affect star ratings and publicly reported outcomes.
- Coding Plus + POC: Coding Plus with review and recommendations for the plan of care.
- OASIS Review: coding plus a review of all M-items and GG items for accuracy.
- OASIS Plus POC: OASIS Review with review and recommendations for the plan of care.
- Discharge: review of all discharge OASIS items for accuracy.
- Hospice Coding: diagnosis coding for hospice.
- Preceptor Partnership: live sessions in which our team reviews OASIS documentation with your clinicians after their assessments, so they learn from each recommendation.
(HealthRev OASIS Review). Velocity, our platform, tracks chart status, clinician productivity, and the top OASIS changes, alongside the EHR you already use (Velocity).
Frequently asked questions
How often are home health star ratings updated?
Quarterly, in January, April, July, and October (CMS).
Can we dispute our star rating?
You can request a formal review of your Quality of Patient Care star rating, following the instructions CMS posts with the Provider Preview Report and by the deadline on CMS’s calendar (CMS Star Ratings; CMS Data Submission Deadlines). Accuracy problems in submitted assessments can’t be fixed that way, which is why review before submission matters.
Is Acute Care Hospitalization still in the star rating?
No. CMS replaced it with Home Health Within-Stay Potentially Preventable Hospitalization as of the October 2024 refresh (CMS QoPC Methodology).
Does all-payer OASIS change our star rating?
Not today. CMS calculates OASIS-based measures only for Medicare FFS, Medicare Advantage, Medicaid, and Medicaid managed care patients, and says it will notify providers of any future uses (CMS).
Is OASIS accuracy about getting higher scores?
No. The goal is scores that match the patient and the clinical record. Accurate documentation supports compliance, fair payment, and outcomes that reflect your team’s care.
Want a second set of eyes on what’s driving your star rating? Talk to a Specialist about OASIS review built for your agency.
