Falls with Major Injury Revamped: New Requirements in 2026 for Home Health Providers

Falls are among the most costly and dangerous risks in home health and now reporting them has changed in a big way. Effective January 1, 2026, the Centers for Medicare and Medicaid Services (CMS) updated the Falls with Major Injury (FMI) measure, impacting patient safety and quality of life, costs, outcomes and organizational performance across post-acute care.

This change represents a broader push to more accurately document patient safety, reduce underreporting and better align quality data with patient outcomes.

Why the FMI Measure Changed

Approximately 20-30% of older adults (≥ 65 years old) experience one or more falls each year, which can result in serious injury, reduced functioning and increased financial burden. The Office of Inspector General (OIG) found substantial underreporting of FMIs in assessment data across settings. Specifically in home health, the OIG reported that in 2023, less than half of claims-identified FMIs in patients under a home health plan of care were reported in OASIS assessments. They also found that some of the agencies that had the best falls scores in Care Compare had the worst fall rates.

To address the gap, CMS moved beyond the OASIS assessment as a single data source by incorporating claims into the measure. The goal is to gain a more complete picture of patient safety by incorporating multiple inputs.

Moving forward, CMS will combine:

• OASIS assessment data (items J1800 and J1900)
• Medicare fee-for-service claims for injuries
• Medicare Advantage encounter data related to injuries
• Medicaid claims and encounter data related to injuries
• External cause codes from hospital, emergency department and observation stays

CMS is cross-checking injury claims from hospital, ER and observation visits with home health patient quality episodes to help obtain more accurate outcomes and reduce underreporting. Even if a fall or injury is not documented in OASIS, it may still be identified through claims and encounter data and factored into the agency’s FMI calculation.

Definition Changes and Updates

Along with the change to data collection, CMS revised definitions surrounding falls. A fall is defined as an unintentional change in position coming to rest on the ground, floor or onto the next lower surface (e.g., onto a bed, chair or bedside mat). The fall may be witnessed, reported by the patient or an observer, or identified when a patient is found on the floor or ground. An intercepted fall, in which the patient would have fallen, but caught themselves, or another person catches them before they fall to the next lowest surface, is considered a fall.

A major change is that a fall can now be due to an overwhelming external force, like a patient pushing another patient. Even if it’s just a stumble backwards and they catch themselves, it’s still considered a fall.

For years, an intercepted fall during balance training was not considered a fall. The new exception is an intercepted fall during balance training resulting in the patient having a major injury. Because it resulted in a major injury, the fall would be considered a fall with major injury. An anticipated loss of balance that is safely managed is not considered a fall. Only if such a circumstance occurs that it results in a major injury, is it a fall.

What constitutes an injury has also been redefined. Injuries except major are injuries like bruises, sprains, cuts or any complaints of pain. Major injuries include, but are not limited to, fractures, dislocations, head injuries and internal trauma. The definitions have been removed from OASIS items J1800 and J1900 and are now expanded in the OASIS-E2 manual. CMS did not provide an exclusive list and expects clinicians to use judgment to determine if the injury is major or not major.

What This Means for Documentation in Home Health

Expectations for accuracy are now higher. The OASIS remains central to the FMI measure, with J1800 recording whether a fall occurred, and J1900 documenting the number and severity of falls. Clinicians must accurately identify and document falls, relying more heavily on the OASIS manual for definition since there are no embedded examples.

Timing of your documentation also matters. A fall that happens anywhere and anytime during the home health quality episode must be reported. This includes falls that happen outside the home, and even at the doctor’s office or during outpatient surgery.

CMS expects agencies to update OASIS assessments if any new information comes to light. For example, if you find out after initial documentation that an injury was a fracture, the assessment should be corrected using agency policy.

Strengthening Documentation & Workflows

Home health organizations need to take a proactive approach to documentation to keep pace with all the changes. It starts with assessing for falls at every visit. Simple, direct questions can help uncover events that might otherwise go unreported, including near-falls or situations where a patient was caught before hitting the ground.

Once a fall is identified, the documentation needs to provide detailed context. Capture where and when the fall occurred, the cause, direction of the fall and contributions to the fall, like medication changes, environmental hazards or mobility limitations. It’s also important to document whether the patient sought medical care and whether a major injury is suspected, even if confirmation is pending. Fall prevention should be a part of every care plan.

A New Standard for Patient Safety

The 2026 updates to the Falls with Major Injury measure signify more than a regulatory change. They reflect a broader shift toward data accuracy and accountability in home health.

For providers, the path forward is clear. Capture every fall. Document thoroughly. Align clinical insights with external data. By doing so, organizations will meet compliance expectations and gain a clearer understanding of patient needs and opportunities to improve care.