CMS Proposes 2027 Home Health Agency Payment Rule Aiming to Enhance Quality and Combat Fraud
The Centers for Medicare and Medicaid Services (CMS) unveiled its proposed 2027 home health agency payment rule, which includes significant changes to payment methods, quality reporting, and anti-fraud measures. This proposal is part of CMS’s ongoing effort to improve healthcare delivery while safeguarding taxpayer dollars.
Payment Increase and Methodology Updates
Under the proposed rule, home health agencies would see an overall payment increase of $420 million, or 2.4%. This increase is driven by a 2.1% payment update, amounting to $370 million, and an estimated 0.3% increase related to the fixed dollar loss rate. These adjustments reflect CMS’s commitment to ensuring fair compensation for home health services while maintaining fiscal responsibility.
Enhancing Access to Home-Based Care
CMS is also seeking feedback on ways to expand access to home-based palliative care. By promoting community-based palliative care services, CMS aims to provide patients with more options for receiving care at home, thereby enhancing their quality of life. Engaging stakeholders in this dialogue underscores CMS’s dedication to meeting the evolving needs of Medicare beneficiaries.
Strengthening Anti-Fraud Measures
Beyond payment updates, the proposed rule introduces robust anti-fraud measures. These include making all Medicare enrollment revocations retroactive and expanding CMS’s authority to deny or revoke enrollment for providers and suppliers with compliance violations. Such measures are designed to protect Medicare resources and ensure that only qualified providers participate in the program.
In line with the Trump administration’s focus on combating fraud, CMS previously imposed a six-month moratorium on new hospice and home health agency enrollments in Medicare. This “data-driven” approach targets significant sources of fraudulent activity and aligns with similar actions taken against manufacturers of durable medical equipment.
Improving Transparency and Quality Reporting
To enhance transparency, CMS proposes shortening the timeline for submitting Outcome and Assessment Information Set data from 4.5 months to 45 days. This change would allow Medicare patients to access quality information sooner, enabling them to make informed care decisions.
Additionally, the proposed rule includes updates to the Home Health Quality Reporting Program, aligning it more closely with the expanded Home Health Value-Based Purchasing model. These updates reflect CMS’s ongoing efforts to incentivize quality improvements in home health care.
Addressing Durable Medical Equipment and Provider Enrollment
The proposal also includes updates for durable medical equipment, prostheses, orthoses, and supplies. Notably, CMS plans to expand Medicare DME coverage beginning April 1, 2027, to include certain external infusion pumps and associated home infusion medications. This expansion is part of CMS’s broader strategy to ensure comprehensive coverage for essential medical equipment.
Furthermore, CMS is proposing several changes to the Medicare provider enrollment process. These include new grounds for revocation or denial of enrollment, particularly for providers posing a high risk of fraud. By tightening enrollment criteria, CMS aims to enhance the integrity of the Medicare program.
For additional details, please refer to the full proposed rule available Here.
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