Home care is the area where this revision replaced the evaluation axis itself.
Until now, home-care fees accumulated as you accumulated visits and patients. FY2026 draws a clear line through that. The twice-monthly tiers of the home-care management fee (zaitaku sogo kanri ryo) and the facility-residence management fee now require that at least 20% of patients be severe cases or subject to the comprehensive support add-on.
Two practices with identical visit volumes can now diverge: if the severity mix falls short of the threshold, the twice-monthly management fee cannot be billed at all. The shift from volume to quality has been implemented at the level of the fee schedule.
Note: This article organizes publicly available material. The official texts are the ministry notification and the regional bureau circulars. Always confirm billing and filing decisions against primary sources.
1. What changed
| Item | Change | Points | Impact |
|---|---|---|---|
| Home-care / facility-residence management fee (twice-monthly tiers) | Added requirement that 20% or more of patients billed twice monthly be severe cases or subject to the comprehensive support add-on. Practices below 20% must file a notification | Requirement added | Large |
| Relaxation of the above | Where the practice meets a set standard for severe dementia care (dementia independence level IV or M), the threshold drops from 20% to 15% (confirm against primary sources) | Requirement relaxed | Medium |
| Home-care capacity add-on (new) | Restructures the former palliative-care capacity add-on. Evaluates the whole delivery capacity — severe cases, end-of-life care, and pediatric home care — not palliative care alone | 400 → 800 points for a single-building patient count of one (confirm against primary sources) | Large |
| Home-visit patient counting | For the "100 or fewer patients per full-time-equivalent physician" standard, patients billed at the multi-patient-per-building rate and patients visited monthly may now be counted as 0.5, up to a cap of 70 | Requirement relaxed | Medium |
| Home-visit nursing information-coordination add-on (new) | Evaluates reviewing information recorded via ICT by physicians, pharmacists, and care managers while conducting planned management in parallel. Billed by the home-visit nursing agency | ¥1,000 once monthly (confirm against primary sources) | Medium |
| Simultaneous physician-pharmacist home guidance fee (new) | Evaluates a physician and pharmacist visiting together to provide medication guidance | 300 points (confirm against primary sources) | Small–Medium |
| Same-building rules for home-visit nursing | Finer tiers by number of users in the same building and monthly visit days. Buildings on the same premises now also count as the "same building" | Revised | Medium |
| Home-care inflation-response fee, base-up evaluation fee | Common to all specialties. Cannot be billed without filing | New / revised | Large |
2. Business impact and what to do
(1) The severe-patient share must not be a number you discover at closing.
This is the single change that most alters day-to-day practice. A 20% severe-patient share is not something that emerges from a year-end tally — it is a direct reflection of your ongoing patient mix. And because the home-care management fee sits at the core of a home-care practice's revenue, losing the twice-monthly tier is a large revenue event.
The share is verified by the practice each February, May, August, and November, and where it changes, filed promptly within that same month using form 19 to the regional bureau director (confirm against primary sources). Practices that were billing as of 31 March 2026 are covered by this framework from 1 June onward.
The next checkpoint is November. Even practices that completed the August check will get a different answer if their patient mix has shifted since. Not being able to state your current share in October is itself the risk.
(2) The home-care capacity add-on rewards only those who already have the track record.
Going from 400 to 800 points for a single-building patient count of one is a large increase, but only enhanced-function home-care support clinics that meet the emergency house-call and end-of-life care volume requirements qualify (confirm against primary sources). Put the other way: this revision widens the gap against practices that cannot meet those requirements.
Because it restructures the former palliative-care capacity add-on, reading it as "we don't do palliative care, so this doesn't apply" is a mistake. It has become an evaluation of overall delivery capacity, including severe cases, end-of-life care, and pediatric home care.
(3) The patient-count relaxation matters most to practices with facility patients.
Against the standard of 100 or fewer patients per full-time-equivalent physician, patients billed at the multi-patient-per-building rate and patients visited monthly can now be counted as 0.5, up to 70. For practices carrying a meaningful volume of facility visits, this counting method decides whether the standard is met. It is worth recalculating how many patients you have under each method.
(4) Home-visit nursing has entered the stage where ICT coordination is a billable item.
The home-visit nursing information-coordination add-on evaluates reviewing information recorded via ICT by physicians, pharmacists, care managers, and other professionals, and conducting planned management in parallel. Eligible systems are described as those where multiple professions share and use clinical information under corporate management.
Two cautions. First, it cannot be billed alongside the home-patient coordination guidance add-on or the home-care information-coordination add-on. Second, the facility standard includes posting inside the agency and publishing on a website, and the transitional period runs to 30 September 2026 (confirm against primary sources). If posting and publication are not yet done, very little time remains.
(5) House-call volume reporting for collaborative enhanced-function clinics.
Addressing collaborative enhanced-function home-care support clinics with insufficient house-call activity, all practices filing the home-care or facility-residence management fee were required in August 2026 to verify whether they met the house-call standard and report to the regional bureau director (confirm against primary sources). Check your filing records for gaps.
3. Practical checklist
- Can you state your current severe-patient share right now?
- Have you decided how to handle the twice-monthly tier if you fall below 20% (or 15% where the relaxation applies)?
- Do you have a way to track the share monthly ahead of the November checkpoint?
- Have you assessed whether the severe-dementia relaxation applies (it presumes records of decision-making support and information sharing for level IV or M patients)?
- Do you meet the emergency house-call and end-of-life volume requirements for the home-care capacity add-on, and can you evidence them from records?
- Have you recalculated patients per full-time-equivalent physician under the relaxed counting method?
- Have you completed posting and web publication for the home-visit nursing coordination add-on by 30 September?
- Have you filed for the home-care inflation-response fee and the base-up evaluation fee?
- Did you submit the August 2026 house-call standard verification report?
4. How an AI-native chart helps — feature by feature
For home care, 2026 is a move from "accumulate visits" to "manage patient mix and track record." The number of things to manage went up; the time available to type at the bedside did not. Here is how Pottech's AI chart supports that, feature by feature.
Feature 1: Management dashboard — know the severe-patient share before month-end
Visit volume, revenue per patient, and monthly trends are aggregated and visualized automatically.
The severe-patient share is precisely the kind of metric that must not first appear in a tally. How many patients are billed twice monthly, and how many of those are severe or subject to the comprehensive support add-on — those two counts give you the share, and both already live in the chart.
Tracking it monthly means seeing a shortfall coming. Emergency house-call and end-of-life counts work the same way: whether you meet the capacity add-on requirements is simply the sum of your daily records.
Feature 2: Billing and claims — tier determination and mutual-exclusion checks
The automatic billing engine checks bundling, mutual exclusions, and frequency limits, and determines billability.
Home care is dense with branching. Home-care versus facility-residence management fee, point variation by single-building patient count, monthly versus twice-monthly tiers — all of these shift per patient and per month. This revision adds another relationship: the home-visit nursing coordination add-on cannot be billed alongside the home-patient coordination guidance add-on or the home-care information-coordination add-on.
The more items depend on human memory, the more both missed billing and audit deductions rise. Having the system stop the error is the practical answer once requirements get this intricate.
Feature 3: Mobile and offline — finish the record at the bedside
Tablets and smartphones keep recording available even where connectivity is unreliable.
More requirements means more records that must exist. Decision-making support for severe dementia patients, information sharing with partner organizations, emergency house calls — each becomes evidence for billing and filing. Reconstructing these from memory after returning to the office does not produce accurate records.
Whether the record can be completed on site translates directly into how reliably you can file.
Feature 4: Integration and APIs — connect multidisciplinary ICT to the record
An OAuth2 gateway, MCP server, and HAPI FHIR support integration with external systems.
What the home-visit nursing coordination add-on signals is that ICT-based information sharing has become a billable activity. With the national rollout of the electronic health record sharing service ahead, home care is the field where multidisciplinary coordination gets wired into the national infrastructure.
Lowering the cost of coordination directly widens the range of add-ons you can bill.
Also review the items common to all specialties
Changes common to every specialty — initial and follow-up consultation fees, the inflation-response fee, base-up evaluation fees, and the electronic clinical information coordination add-on — are collected in "Items Common to All Specialties."
For the business structure of home-care practices themselves, see "Home Care Management Trends 2026."
Sources (principal)
- MHLW, "On the FY2026 (Reiwa 8) Fee Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Kyoto Medical Practitioners Association, "On filing the home-care management fee under the FY2026 revision" https://healthnet.jp/informations/informations-53792/
- GemMed, "FY2026 fee revision notifications corrected; relaxation of home-care standards reflected in facility standard circulars" https://gemmed.ghc-j.com/?p=74354
- Mediva, "FY2026 fee revision (3): home care and home-visit nursing enter an era judged on quality and efficiency" https://mediva.co.jp/report/revision/19198/
- CareTeam, "FY2026 fee revision: the new home-visit nursing information-coordination add-on" https://careteam.jp/column/column064