11/10/2026

CMS Finalizes 2027 Home Health Rule: Payment Updates and Expanded Oversight for Home Health and Hospice

CMS released the CY 2027 Home Health Prospective Payment System Final Rule on November 4, finalizing payment and quality reporting changes for home health agencies alongside significant Medicare enrollment and program integrity provisions that will also affect hospice providers.

What changed

Home health payment: CMS projects a 2.4% aggregate increase in Medicare home health payments for 2027, approximately $415 million nationwide. However, the rule retains a 3% temporary reduction to the national standardized payment rate to continue recouping prior overpayments associated with the Patient Driven Groupings Model (PDGM). No additional permanent behavioral adjustment was finalized for 2027.

Expanded Medicare oversight: CMS finalized most of its proposed changes to Medicare enrollment and revocation authority, including:

• Allowing Medicare enrollment revocations to take effect retroactively to the date noncompliance began.
• Expanding grounds for enrollment denial or revocation, including certain geographic risk factors, ownership and affiliation concerns.
• Strengthening requirements involving changes in majority ownership for home health agencies and hospices.
• Adding hospice specific enrollment safeguards related to medical director and administrator arrangements.

Additional home health changes: CMS also finalized updates to quality reporting deadlines and clarified that eligible patients may receive skilled palliative care under the existing Medicare home health benefit. Additional CMS guidance on palliative care services is expected.

Why it matters

While the projected payment increase offers some relief for home health agencies, reimbursement pressures remain. For both home health and hospice, the expanded Medicare enrollment authorities introduce additional compliance risks, particularly involving ownership, leadership, enrollment disclosures and potential retroactive payment recovery.

LeadingAge has raised concerns that these broad enforcement provisions could unintentionally affect compliant providers and continues advocating for more targeted oversight that protects both program integrity and access to care.

What to do

• Home health agencies: Review the finalized payment and quality reporting changes with finance, clinical and compliance teams as part of 2027 planning.
• Home health and hospice providers: Review Medicare enrollment records, ownership disclosures and managing employee information for accuracy.
• Evaluate whether planned ownership or organizational changes could trigger new enrollment or survey requirements.
• Review LeadingAge's analysis of the finalized enrollment provisions and prepare for implementation.