CMS released the Calendar Year 2027 Medicare Home Health Prospective Payment System (HH PPS) final rule on November 4, 2026, with official publication on November 9, 2026.
Payment & Rate Updates
- 2.4% Net Payment Increase: Driven by a 3.1% market basket update minus a 1.0% productivity adjustment (+2.1%), plus approximately 0.3% in outlier adjustments.
- Standardized 30-Day Rate: Set at $2,092.69 before case-mix and wage adjustments. A 0.9700 factor is applied to recover historical PDGM overpayments, maintaining the previous year's 3% temporary cut without adding a new reduction.
- Therapy LUPA Per-Visit Rates: Base rates rise to $197.46 (PT), $198.81 (OT), and $214.64 (SLP) for qualifying agencies. The 3% temporary adjustment does not apply.
- Wage Index: Continues using hospital wage data, maintaining the 5% cap on annual decreases.
Clinical & Quality Reporting
- Palliative Care Rehabilitation: CMS affirms coverage for skilled therapy focused on maintenance and preventing deterioration in palliative home care. No separate billing code or add-on is established.
- Accelerated OASIS Deadlines: The quarterly submission window is shortened from ~4.5 months to the 15th day of the second month following the quarter's end.
- Calendar-Year Transitions: OASIS and HHCAHPS transition to calendar-year data for APU calculations (2028 APU uses partial 2026 data; 2029 APU uses full CY 2027 data). Noncompliance carries a two-percentage-point APU reduction.
Provider Enrollment & Compliance
- Expanded Revocation Authority: Retroactive revocations can now be applied across all revocation grounds. Following a revocation notice, the claim submission window drops from 60 days to 15 calendar days.
- Managing Employee Definition: Explicitly expanded to require disclosure of clinical leadership, including medical directors, clinical directors, nursing directors, department heads, and supervising physicians.
- Heightened Screening: Qualifying misdemeanor convictions (financial misconduct, sexual assault) within the past 10 years involving leadership or owners are grounds for denial or revocation. False statements on any enrollment-related form (including EFT documentation) carry denial/revocation penalties.
- Risk & Co-Location Factors: CMS adds oversight for high-risk geographic concentrations and shared office suites with revoked or denied entities. Affiliation reviews now extend to indirect relationships and shared vendors presenting undue risk.
