Ask your clinical managers what the HHCAHPS survey asks patients, and most will describe the old one: which staff came, whether anyone checked every medicine, how long the office took to call back. Since the April 2026 sample month, patients have been answering a different survey. Three of its questions are new, and one of them asks whether staff seemed to care about the patient as a person.
The revised HHCAHPS survey is shorter, its star rating is built differently, and its first full public scores are expected in October 2027 from data collected starting in April 2026. This guide covers what changed question by question, how the publicly reported measures were rebuilt, the reporting timeline, and a plan to act on the new questions while there is still time to move the score.
Who Runs the HHCAHPS Survey and Why It Matters
The official HHCAHPS website explains the participation rule: to receive the full annual payment update, agencies that do not qualify for an exemption must contract with an approved survey vendor, administer the survey monthly and have data submitted quarterly. Agencies may apply for an exemption based on the number of survey-eligible patients served in a set 12-month period. The questionnaire itself cites 42 CFR 484.255(i) as the basis for the requirement.
CMS finalized the revised survey in the CY 2026 home health final rule, published December 2, 2025, beginning with the April 2026 sample month. The rule chose not to run old and new surveys side by side, citing small sample sizes and the cost of fielding two instruments. The current English questionnaire carries OMB number 0938-1066 with an expiration of March 31, 2029, and is marked for use starting with the April 2026 sample month.
What Changed: 34 Questions Down to 25
The question crosswalk maps the original 34 questions to the updated 25. The FAQs for the updated survey summarize the changes:
Three new questions: - Whether the care helped the patient take care of their health. - Whether the patient's family or friends got enough information and instructions. - Whether the patient felt the staff cared about them as a person.
Removed: - Four medication questions: whether someone asked to see all medicines, whether medicines were new or changed, whether staff explained the purpose of new medicines, and when to take them. Six medication questions became two. - Three questions about which type of staff visited: nurse, therapist, aide. - The question on whether the patient was told what care and services they would get at the start. - From the crosswalk, the questions on how long the office took to help, and whether the patient had any problems with care.
Reworded: "Home health providers" became "home health staff" throughout. The home safety question now asks whether staff talked about ways to make the home safer, with examples such as grab bars and removing tripping hazards. The medication review question asks whether anyone has ever reviewed prescribed and over-the-counter medicines, for example by asking to see them.
How the Star Rating Is Rebuilt
The crosswalk of publicly reported measures and the FAQs set out the new structure. The old summary star rating used the Overall Rating and three equally weighted composites. The new one uses:
- Overall Rating of Care, unchanged apart from "providers" becoming "staff."
- Care of Patients (modified), now including the new questions on caring about the patient as a person and whether services helped the patient take care of their health, alongside courtesy and respect, gentleness and staff awareness of the patient's care.
- Communications Between Providers and Patients (modified), now including whether family and friends got enough information, alongside arrival-time updates, clear explanations, listening and office help.
- Three stand-alone measures replacing the retired Specific Care Issues composite: Talk About Home Safety, Review Medicines, and Talk About Medicine Side Effects.
Willingness to Recommend continues to be reported. Each stand-alone measure rests on a single question, which means one habit, such as reviewing every medicine at start of care, now moves a published measure directly.
Adjustments and the Reporting Timeline
Two technical changes affect how your score compares with others. CMS dropped the patient-mix adjustment for diagnoses of schizophrenia or dementia, which testing found was no longer significant. And it added a survey mode adjustment, with mail-only as the reference mode, because the 2022 mode experiment found people answer differently depending on how they are surveyed. If you use telephone or mixed mode, your published score will be adjusted to what a mail survey would have produced.
The timeline, assuming the April 2026 launch, per the FAQs:
- April 2026 sample month: updated survey fielded.
- July 2026: last quarterly submission of original-survey data, for Q1 2026.
- After two full quarters of updated data: new measure scores in confidential HHCAHPS preview reports.
- Interim: Overall Rating and Willingness to Recommend keep being reported, with quarters from both surveys combined in the rolling four quarters.
- October 2027: anticipated first Care Compare refresh with the new measures, using data from Q2 2026 through Q1 2027.
That last point is the one to act on. The patients your agency discharges between now and the end of March 2027 are the ones whose answers will make up the first public scores.
A Worked Example: One Question, One Measure
The figures are illustrative, not benchmarks. An agency returns about 60 completed surveys a quarter. On the medication review question, 42 of 60 respondents answer yes, a 70% score before adjustment. An internal audit of 30 start-of-care visits finds that clinicians reconciled medications in the record every time, but in only about two thirds of visits did the patient see it happen: the nurse copied the list from the referral and confirmed a few items verbally.
The fix is a behavior, not a form. The nurse asks the patient to bring out every bottle, including over-the-counter products, and goes through each one at the table. That is close to what the question now describes. If the share of patients who experience that rises to 90%, the measure can follow, with a lag, because public scores use four rolling quarters.
The same logic applies to Talk About Home Safety and Talk About Medicine Side Effects. Each is one question, answered by every respondent who reached it, and each maps to one moment in the visit. They are the most controllable measures in the new rating, and the ones least likely to improve on their own.
Small Agencies and Exemptions
Agencies with low volume should check their status every year rather than assume it carries over. The HHCAHPS website hosts the participation exemption request form and the participation periods, and the exemption depends on counting survey-eligible patients for the specified 12-month period. Small samples also make scores volatile: with few respondents each quarter, a handful of answers can swing a measure several points, which is a reason to manage the underlying habits rather than chase each quarter's number.
A Plan for the Next Five Months
- 1.Read the new survey with your managers. Download the questionnaire and go through it item by item. Most staff have never seen the wording patients receive.
- 2.Map each measure to a moment in care. Home safety talk and medication review belong at start of care. Side effects belong at every medication change. Family information belongs in teaching and discharge planning. Arrival-time updates belong to scheduling.
- 3.Make the stand-alone items routine and visible. Add a home safety discussion and a full medicine review, with the patient shown the result, to the start-of-care visit. Document that they happened.
- 4.Address the family question deliberately. Ask at admission who helps the patient and what they need to know, then give that person instructions at the right points, within the patient's privacy wishes.
- 5.Fix arrival-time communication. Patients are asked how often staff kept them informed about when they would arrive. A same-day call or text when a visit time changes is a scheduling process, not a clinical one.
- 6.Watch the preview reports. Track the new measures each quarter once available, by branch and team where sample sizes allow.
- 7.Do not script answers. Coaching patients on how to respond is not the goal. Changing what they experience is.
The OASIS-E2 home safety and medication items covered in the OASIS-E2 rework guide happen at the same visits these survey questions ask about, so align the two in your start-of-care template.
Where Systems Help
The new measures reward things that happen at specific visits and are easy to forget under time pressure. Nuraflow is being designed so that quality assurance routes start-of-care documentation to named reviewers with configured checks, and reports and analytics show trends by discipline and location from the same records.
This article is general information. Confirm survey requirements, exemption eligibility and reporting dates on the official HHCAHPS website and with your approved survey vendor.