Calendar Year 2027 Home Health Prospective Payment System (HH PPS) Rate Update; Requirements for the HH Quality Reporting Program and the Expanded HH Value-Based Purchasing Model; Medicare Provider Enrollment, Durable Medical Equipment (DME), and DME, Prosthetics, Orthotics, and Supplies (DMEPOS) Policies
Key claim: CMS proposes routine CY 2027 updates to Medicare home health prospective payment rates, case-mix weights, LUPA thresholds, quality reporting requirements, and DMEPOS enrollment and benefit policies.
Abstract
(Proposed Rule · Health and Human Services Department, Centers for Medicare & Medicaid Services) This proposed rule would set forth routine updates to the Medicare home health payment rates in accordance with existing statutory and regulatory requirements. In addition, this proposed rule discusses the behavior adjustment and proposes a temporary behavior adjustment and proposes to recalibrate the case-mix weights and update the functional impairment levels; comorbidity subgroups; and low- utilization payment adjustment (LUPA) thresholds for CY 2027. Additionally, this proposed rule discusses the provision of home health palliative care services and includes a request for information (RFI) on a home health specific wage index. This rule would also propose changes to the Home Health Quality Reporting Program (HH QRP) and summarizes potential initiatives to improve alignment between the HH QRP and expanded Home Health Value Based Purchasing (HHVBP) Model. Lastly, the rule would–clarify the application of the DMEPOS face-to- face encounter requirements for the replacement of DMEPOS items; make changes to the provider and supplier enrollment requirements; make changes regarding DME benefit expansion for infusion pumps and drugs; and discuss collection of information requirement changes regarding the DMEPOS Competitive Bidding Program (CBP) country of origin.
Why this matters
The annual Home Health PPS rule sets Medicare payment rates and quality reporting requirements for home health agencies serving beneficiaries recovering at home, and the accompanying DMEPOS provisions affect enrollment and coverage of durable medical equipment. Changes here directly influence what home health providers are paid, which agencies can bill Medicare, and what supplies are covered for beneficiaries. As a proposed rule, the details remain subject to public comment before finalization.