Photo: Carol M. Highsmith / Library of Congress / Archive
Medicare plans to pay home-health agencies more in 2027, while giving itself stronger powers to take money back from providers that break the rules. The two changes arrive in the same final rule, with consequences for both care at home and the businesses delivering it.
The Centers for Medicare & Medicaid Services estimates that payments to home-health agencies will rise by $415 million, or 2.4%, compared with 2026. That is an estimate for the sector as a whole, not a promise that every agency will receive a 2.4% increase.
Why the 3% adjustment is not a new cut on top
The November 4 rule continues a temporary 3% reduction to the home-health base payment rate as CMS recoups past payments linked to changes in its payment model. But that same adjustment applies in 2026.
In its final-rule impact analysis, CMS says the adjustment has no additional aggregate effect when comparing 2027 with 2026. Subtracting 3% from the announced 2.4% increase would therefore give readers the wrong year-over-year picture.
The projected increase consists of a 2.1% home-health payment update and an estimated 0.3% increase tied to payments for unusually costly cases. Individual agencies can see different results because of wage-index changes, patient mix, use of services and other payment factors.
The payment provisions take effect January 1, 2027. The rule is on public inspection and scheduled for publication in the Federal Register on November 9.
Medicare can look further back when enrollment is revoked
The rule also broadens Medicare’s ability to make an enrollment revocation effective from the date noncompliance began. That matters because it can allow CMS to recover payments going back to that date, rather than only stopping future payments.
Those provisions reach across Medicare provider and supplier types. They are not limited to home-health agencies simply because they appear in a home-health payment rule.
CMS is adding or expanding grounds for denying or revoking enrollment, including certain misdemeanor convictions involving sexual assault or financial misconduct. It also addresses cases where an excessive concentration of providers or suppliers in a limited geographic area creates a high risk of fraud, waste or abuse.
The agency says it will consider the facts and circumstances of individual cases. It estimates the changes could save taxpayers about $82 million a year. That figure is the agency’s projection, not money already recovered.
Families could get newer quality information
CMS is shortening the deadline for submitting home-health assessment data from 135 days to 45 days. It says this could make public quality information available up to three months sooner. About 98% of agencies already submit within 45 days, according to CMS.
For a family comparing agencies, more current data could make the comparison more useful. It still does not replace checking whether an agency serves the patient’s area, can provide the needed care and accepts the patient’s coverage.
The rule also discusses skilled palliative care under Medicare’s existing home-health benefit. Palliative care focuses on symptoms and support during serious illness. CMS says this does not create a new benefit, and patients must still meet Medicare’s home-health eligibility requirements.
That care is distinct from hospice. CMS plans to give providers further examples of covered skilled palliative services in later guidance.
JBizNews Desk | Washington
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