CMS released the CY 2027 Home Health Prospective Payment System final rule on November 4, 2026, and it runs 447 pages. In this episode of Home Health Revealed, Hannah Vale, CEO of HealthRev Partners, walks through what’s in it in plain English and what your agency should do before January 1.
The short version: rates go up a little, the big cut agencies were bracing for didn’t happen, and some deadlines get tighter.
Hannah covers:
- The headline: CMS estimates home health payments rise 2.4% in 2027, about $415 million. That is a 2.1% payment update plus about 0.3% from the outlier change, in line with July’s proposal.
- The national 30-day base rate goes from about $2,038 to $2,092.69, before wage index and case mix. Your agency’s number will differ from the national average.
- No new permanent PDGM cut for 2027, but CMS kept the -3% temporary adjustment. It still aims to recover about $4.9 billion it believes was overpaid through 2025.
- Outliers get easier to reach: the fixed-dollar loss ratio drops from 0.37 to 0.29.
- LUPA thresholds: 10 payment groups drop by one visit, and one group goes up by one visit.
- Comorbidity groups grow to 22 low groups and 103 high combinations (proposed: 21 and 100), with recalibrated case-mix weights and functional levels.
- OASIS deadlines tighten: starting with 2027 data, submissions and corrections are due by the 15th day of the second month after the quarter ends. For Q1 2027, that’s May 17, 2027. Missing quality reporting still costs 2 percentage points.
- Medicare enrollment gets stricter: new grounds for denial and revocation, broader retroactive revocations, and reapplication bars after a denial for any reason.
- What’s not in the rule: no HHVBP model changes and no changes to the Review Choice Demonstration.
- A five-step to-do list before January 1.
Correction: In the episode, Hannah says the fixed-dollar loss ratio drops from 0.39. The correct figure in the final rule is 0.37, dropping to 0.29.
Read the rule (Federal Register public inspection, document 2026-22750): https://www.federalregister.gov/public-inspection/2026-22750/calendar-year-2027-home-health-prospective-payment-system-rate-update-requirements-for-the-hh
Missed our California RCD episode? Listen to episode 137: https://healthrevpartners.com/podcast/137-california-rcd-what-home-health-agencies-need-to-know/
Want a second set of eyes on how 2027 hits your agency? HealthRev Partners helps home health agencies with coding and OASIS review, billing and revenue cycle, and RCD pre-claim review. Reach out at https://healthrevpartners.com/
Watch on YouTube: https://youtu.be/0znS-uoUfzY
Timestamps:
00:00 Intro: Home Health Revealed
00:20 The final rule is here: 447 pages, the short version
01:27 What the annual home health payment rule does
02:12 The headline: payments up 2.4% (about $415 million)
02:43 How the final rule compares to the July proposal
03:02 The new national base rate per 30-day period
03:39 No new permanent cut, but the 3% temporary cut stays
04:51 Outliers get easier to reach
05:29 LUPA thresholds shift
06:13 Coding and comorbidity groups
07:09 OASIS deadlines get much tighter
08:35 Medicare enrollment gets stricter
09:15 What’s not in the rule: HHVBP and RCD
09:40 What changed from the proposal
10:19 Your to-do list before January 1
12:09 Recap, and how HealthRev Partners can help
