Medicare Tweaks Home Health Payments and Rules for 2027
Published Date: 7/6/2026
Proposed Rule
Summary
Starting in 2027, Medicare is updating how it pays for home health care, including new rules to better match patient needs and improve quality. Home health agencies, equipment suppliers, and providers will see changes in payment rates, reporting, and enrollment rules, with some new policies on medical equipment and services. These updates aim to make care fairer and smoother, with some deadlines and money changes coming next year.
Analyzed Economic Effects
6 provisions identified: 3 benefits, 2 costs, 1 mixed.
CY 2027 Home Health Payment Recalibration
This rule proposes updates to Medicare home health payments for Calendar Year 2027, including recalibrating Patient-Driven Groupings Model (PDGM) case-mix weights and updating low-utilization payment adjustment (LUPA) thresholds, functional impairment levels, and comorbidity subgroups for 30-day periods of care. CMS also proposes a temporary behavior adjustment to the base payment rate and a fixed-dollar loss (FDL) ratio so outlier payments are projected not to exceed 2.5 percent of total aggregate payments.
HH QRP Reporting Window Changes
Beginning with the CY 2027 Home Health Quality Reporting Program (HH QRP), CMS proposes revised data submission deadlines and to change the OASIS and HHCAHPS Annual Payment Update reporting timeframe to a calendar year of data (January 1 through December 31). Under existing law cited in the rule, if an HHA does not submit required quality data, the home health market basket percentage increase is reduced by 2 percentage points.
Stricter Provider Enrollment Rules
CMS proposes adding grounds to deny or revoke Medicare enrollment and expanding reasons CMS can apply a retroactive effective date for revocations. CMS also proposes expanding the ability to bar reapplication (currently up to 10 years for false or misleading enrollment submissions) to permit reapplication bars regardless of the denial reason.
DME Benefit Expanded to Infusion Pumps and Drugs
The rule proposes to revise the Medicare Part B definition of durable medical equipment (DME) at 42 CFR 414.202 to implement section 6222(a) of the Consolidated Appropriations Act, 2026, so that certain external infusion pumps and associated home infusion drugs or supplies are treated as meeting the "appropriate for use in the home" requirement when specified statutory criteria are satisfied.
Clarify DME Replacement Face-to-Face Rule
CMS proposes that a new face-to-face encounter is not required to support Medicare payment for replacement of a DMEPOS item when the replacement is for an item under the same HCPCS code and the original encounter and documentation exist; specifically, an additional face-to-face encounter within the 6 months preceding an order for replacement would not be required under 42 CFR 410.38. Replacement that involves a different item (for example, due to a change in medical condition) is not covered by this clarification.
Country-of-Origin Data for DME Competitive Bids
CMS proposes to require DMEPOS Competitive Bidding Program contract suppliers to report the country of origin for the lead items furnished during a contract's period of performance, and to populate that country-of-origin information in the Medicare Supplier Directory during the contract period.
Your PRIA Score
Personalized for You
How does this regulation affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this federal register document and every other regulation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Key Dates
Department and Agencies
Related Federal Register Documents
2026-12069 — Medicare Program; Strengthening Oversight of Accrediting Organizations (AOs) and Preventing AO Conflicts of Interest, and Related Provisions
This new rule makes sure the groups that check Medicare providers play fair and follow clear rules to avoid conflicts of interest. It updates how psychiatric hospitals are reviewed and tightens rules for providers who lost their Medicare status but want back in. These changes affect Medicare providers and accrediting groups, start June 16, 2027, and aim to keep care safe and trustworthy.
2026-10890 — Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
Starting July 1, 2026, Medicare is updating the Increasing Organ Transplant Access (IOTA) Model to help kidney transplant hospitals do even better at getting more people transplanted and improving care quality. These changes affect hospitals involved in kidney transplants and aim to make the process smoother and more effective, with new payment rules that reward success. This update is part of a 6-year plan running through 2031 to save more lives and boost patient experience.
2026-10292 — Medicaid Program; Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments
This proposed rule changes how states can pay Medicaid managed care plans and certain doctors to make sure payments are fair, efficient, and encourage enough providers to offer quality care. It affects states, Medicaid managed care organizations, and targeted Medicaid practitioners, aiming to keep payments balanced and services available. Comments on these changes are open until July 21, 2026, so stakeholders have time to weigh in before it’s finalized.
2026-10050 — Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program
Starting in 2027, health insurance plans on federal and state marketplaces will see new rules to make coverage fairer and easier to use. These changes affect insurance companies, agents, and people buying plans, including new fees, penalties, and better protections for those with hardships. Expect updates on plan quality, dental coverage limits, and longer-term catastrophic plans, all aiming to keep your health coverage solid and affordable.
2026-07205 — Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability Standards and Prior Authorization for Drugs for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges
This new rule will help Medicare, Medicaid, CHIP, and health plan companies share patient info more easily and speed up drug approval requests. It affects Medicare Advantage, Medicaid, CHIP, and health plans on federal exchanges, aiming to make care smoother and faster. These changes will start soon and could save time and money by cutting red tape.
2026-04797 — Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
This document fixes some typos and technical mistakes in the Medicare and Medicaid payment rules for 2026. It affects doctors, healthcare providers, and anyone using Medicare Part B by clarifying payment policies and program requirements starting January 1, 2026. These corrections help make sure payments and coverage rules are clear and accurate, so everyone gets paid right and on time.
Previous / Next Documents
Previous: 2026-13587 — Fingerprint and Photograph Requirements for Firearms Applications
The ATF wants to make it easier for people applying for firearms by letting them send a photo ID instead of passport-style photos and reducing fingerprint card requirements. This change affects individuals and responsible persons for businesses applying for firearms licenses. Comments on this proposal are open until October 5, 2026, and could save applicants time and hassle.
Next: 2026-13611 — Petition for Reconsideration of Action in Rulemaking Proceeding
DIRECTV, through Brenna Sparks, has asked the FCC to rethink some recent ideas about sharing satellite internet space. This affects satellite companies and could change how they use the airwaves, but no new rules or costs are set yet. If you want to speak up, you’ve got until July 21, 2026, to file your opposition and until July 31 to reply.