CMS Finalizes Home Health Final Rule With Broad Medicare Integrity Changes, Expected to Save $82 Million a Year
The Centers for Medicare & Medicaid Services (CMS) announced on November 4 that it has finalized the Calendar Year (CY) 2027 Home Health Prospective Payment System final rule, including a package of Medicare integrity changes expected to save taxpayers approximately $82 million annually.
The rule strengthens CMS' ability to recover Medicare payments from noncompliant providers and suppliers. Medicare enrollment revocations can now be effective as of the date noncompliance began, allowing the agency to recover payments dating back to that point, and high-risk providers face tighter limits on entering or remaining in the program. The protections apply across Medicare provider and supplier types.
The rule adds new grounds for denying or revoking enrollment, including certain misdemeanor convictions related to sexual assault or financial misconduct, and circumstances in which an enrollment presents a high risk of fraud, waste, and abuse because of an excessive concentration of providers and suppliers within a limited geographic area. CMS said the new authorities are targeted in scope and that it will consider the facts and circumstances of each case while preserving beneficiaries' access to care. The rule also establishes stricter requirements for hospices and home health agencies related to ownership changes and administrator qualifications.
On palliative care, the final rule discusses how Medicare's existing home health benefit can cover skilled palliative care, including pain and symptom management at home. CMS said this addresses provider uncertainty that may have limited use of these services and does not create a new benefit; eligibility depends on a patient's care needs and whether the patient meets Medicare's home health criteria, rather than on a specific diagnosis. Palliative care under the home health benefit is distinct from hospice care. CMS said it plans to provide additional examples of skilled palliative care through guidance following publication of the rule.
Home health quality information will also become public sooner. The rule shortens the Outcome and Assessment Information Set (OASIS) data submission deadline from 135 days to 45 days, which is expected to reduce the public reporting lag by up to three months. About 98% of home health agencies already submit data within 45 days, CMS said. The agency also collected and summarized information on advance care planning as a potential future quality measure concept.
For CY 2027, CMS estimates that Medicare payments to home health agencies will increase by approximately 2.4% compared with CY 2026. The rule also includes a 3% temporary adjustment, consistent with the approach used in the prior year, as CMS continues its transition of the Home Health PPS to the Patient-Driven Groupings Model in a budget-neutral manner. The rule also includes updates related to durable medical equipment, prosthetics, orthotics, and supplies.
"The Trump Administration is taking action to hold noncompliant providers accountable and ensure Medicare works with legitimate, qualified providers," said CMS Administrator Dr. Mehmet Oz. "These changes will help protect seniors, safeguard taxpayer dollars, and preserve access to the care beneficiaries need."
(Source: Centers for Medicare & Medicaid Services)
Source: Centers for Medicare & Medicaid Services
Published by GSM · USA (original Chinese edition)
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