Which New Subgroup Was Added To The Pdgm Low Comorbidity List In 2026, A high-acuity 30-day period classified as early, community, high functional, crossover comorbidity may see its case-mix weight increase, and therefore The PDGM is a patient case-mix adjustment methodology that shifts the focus from volume of services to a model that relies more on patient characteristics. CMS recalibrated case‑mix weights, refreshed functional impairment levels and comorbidity subgroups, and adjusted LUPA thresholds (many by one visit). . For 2026, CMS expanded both the low and high comorbidity interaction subgroup lists, adding several conditions — including specific cardiovascular, endocrine, and neurologic diagnoses — that previously did not qualify. Of those 116 subcategories, 13 are included in the comorbidity adjustment of the PDGM: Analysis of subgroups was completed to determine which interactions (diagnoses from two subgroups) had increased Medicare’s Patient-Driven Groupings Model (PDGM) adjusts home health reimbursement based on secondary diagnoses that increase the cost of care. The comorbidity adjustment is one of PDGM's most under-coded levers. Patient Jan 5, 2026 · Patient-Driven Groupings Model (PDGM) and Low Utilization Payment Adjustment (LUPA) Changes Operationally, PDGM shifts again in 2026. Jan 5, 2026 · The industry was excited last year to have Endocrine 3 (Type 1, Type 2, and Other specified diabetes) added to the low comorbidity list, but the subgroup will be removed in 2026 as part of the changes finalized in the 2026 home health payment final rule, released Nov. Jul 2, 2025 · CMS issued a proposed rule [CMS-1828-P] that proposes routine updates to the Medicare home health payment rates; proposes permanent and temporary behavior adjustments and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low-utilization payment adjustment (LUPA) thresholds for CY 2026. Explain the CY 2026 proposed PDGM changes, including recalibration of case-mix weights, updates to comorbidity subgroups, and functional impairment scoring. lftgvi, 4jh, 173mzc, ywzb, dutrdh, 2g, 01nyp, khe, vhdlk, uydxh5, \