What's in the CY 2027 Medicare home health final rule, and what changed from the proposal?

Not clinically reviewed. Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

By Monsaur Othman · Last updated Nov. 9, 2026, about 7:20 a.m. CT (Federal Register citation and DATES line added)

CMS's CY 2027 home health final rule, published in the Federal Register Nov. 9 at 91 FR 72022, keeps the July proposal's main numbers: a 2.1% payment update, a 3.0% temporary cut and a $2,092.69 national 30-day rate. CMS estimates a net 2.4% ($415 million) increase. Payment provisions take effect Jan. 1, 2027.

Key facts - Published: Nov. 9, 2026, as FR Doc. 2026-22750 (CMS-1844-F), 91 FR 72022–72173 (official PDF). Filed for public inspection Nov. 4. - Update: 2.1%, from a 3.1% market basket minus a 1.0-point productivity adjustment. Agencies that don't submit quality data get 0.1%. - Temporary cut: 3.0% (a 0.9700 factor), about $500 million toward an estimated $4.9 billion. No permanent cut. - 30-day rate: $2,092.69 nationally, standardized ($2,157.41 without the temporary cut). - Net estimate: +2.4%, about $415 million (the proposal said about $420 million). - OASIS: data due by the 15th of the second month after each quarter, starting with Q1 2027 data (due May 17, 2027). - Effective: Jan. 1, 2027, for payment and quality-reporting provisions. For the rest, the published DATES line prints "January 4, 2026" (see below).

What did CMS finalize for 2027 home health payments?

Nearly everything it proposed in July. According to the public-inspection copy of the final rule, the home health market basket increase is 3.1% (based on IGI's third-quarter 2026 forecast). After the 1.0-percentage-point productivity adjustment the law requires, the update is 2.1%. An agency that doesn't submit the required quality data gets 2 points less, or 0.1%.

CMS also finalized the recalibrated case-mix weights, functional impairment levels, comorbidity subgroups and low-utilization (LUPA) thresholds it proposed. On LUPA thresholds, ten case-mix groups drop by one visit and one group rises by one, based on CY 2025 claims pulled July 14, 2026.

How does the final rule compare with the July proposal?

The $5 million difference in the net estimate is the only headline number that moved. CMS doesn't attribute it to any single change in the summary sections we read.

How can there be a 3% cut and a 2.4% increase at the same time?

Both numbers are in the rule, and they measure different things. The 3.0% temporary cut lowers the per-period base rate. CMS's Table B13 starts from the CY 2026 national 30-day rate without a temporary adjustment ($2,101.26). It then applies two budget-neutrality factors (1.0047 for case-mix recalibration and 1.0009 for the wage index) and the 2.1% update to reach $2,157.41. The 0.9700 temporary factor then brings it to $2,092.69. (In the published Federal Register version that table is an image, which our tools could not read as text; the figure is text-verified in the public-inspection copy.)

The 2.4% is CMS's estimate of total 2027 home health spending compared with what it calls an "updated projected CY 2026 baseline" of $17.399 billion. CMS breaks the $415 million into $365 million from the 2.1% update and $50 million (0.3%) from the lower outlier threshold. The rule doesn't say why the temporary cut doesn't show up in that net figure. We report CMS's numbers as written rather than guess, and we'll update if CMS explains.

Your agency's own change will differ. Commenters made the same point, the rule notes: wage index changes, case mix, rural service patterns, LUPAs and outliers all shift results agency by agency.

What happens to the temporary cut after 2027?

It's a one-year adjustment. CMS says the 0.9700 factor won't be built into the CY 2028 starting rate. CMS estimates the 3.0% cut collects about $500 million in 2027, roughly 10% of the about $4.9 billion it calculates in overpayments for 2020 through 2025. It says it may propose more temporary adjustments in future rules.

What else changed: outliers and the wage index?

• Outliers: the fixed-dollar loss (FDL) ratio falls to 0.29, from 0.37 in CY 2026. That makes it easier for high-cost periods to qualify for outlier payments, which the law caps at 2.5% of total payments.
• Wage index: the CY 2027 wage index is based on the FY 2027 hospital pre-floor, pre-reclassified wage index. The permanent 5% cap on year-over-year wage index decreases continues.
• Palliative care and a home-health wage index: CMS responded to comments on palliative care under the home health benefit and summarized feedback on a possible home-health-specific wage index. Neither section finalizes a payment change.

What changes for quality reporting (OASIS)?

Starting with the CY 2027 Home Health Quality Reporting Program, agencies must submit and correct OASIS assessment data by the 15th day of the second month after each calendar quarter, down from about 4.5 months. If that day falls on a Friday, a weekend or a federal holiday, the deadline moves to 11:59 p.m. ET on the next business day. The rule's Table 19 lists the dates for the CY 2029 payment determination:

• Q1 2027 (Jan. 1–Mar. 31): May 17, 2027
• Q2 2027 (Apr. 1–June 30): Aug. 16, 2027
• Q3 2027 (July 1–Sept. 30): Nov. 15, 2027
• Q4 2027 (Oct. 1–Dec. 31): Feb. 15, 2028

CMS says 99.27% of 2024 OASIS assessments were already submitted within 45 days. By its count, the change affects about 0.49% of assessments. OASIS and HHCAHPS reporting for the annual payment update also moves to a calendar-year (Jan. 1–Dec. 31) period. CMS made no changes specific to the expanded Home Health Value-Based Purchasing Model.

What about enrollment, equipment and home infusion?

• Enrollment: CMS added grounds to deny or revoke Medicare enrollment and widened when it can make a revocation retroactive. It also expanded the reapplication bar, which can last up to 10 years and previously applied only to denials for false or misleading information, so it can follow any denial reason. CMS estimates about $82 million a year in transfers from providers to the government from the retroactive-revocation change.
• Signage: CMS finalized its proposal to extend the posted-hours sign requirement to all providers and suppliers (new 42 CFR 424.510(f)). It estimates the cost at about $15.6 million a year across providers.
• DMEPOS replacements: a new face-to-face encounter isn't required to replace an item under the same HCPCS code. An order is still required.
• Home infusion: the definition of durable medical equipment now covers certain external infusion pumps and home infusion drugs when statutory criteria are met, under section 6222(a) of the Consolidated Appropriations Act, 2026.

When does it take effect?

Update, Nov. 9: the rule published Monday at 91 FR 72022. Its DATES section reads, as printed: "With the exception of the HH PPS and HH QRP provisions specified in sections II. and III. of this final rule and the regulatory changes at 42 CFR 484.245, these regulations are effective on January 4, 2026. The HH PPS and HH QRP provisions specified in sections II. and III. of this final rule and the regulatory changes at 42 CFR 484.245 are effective January 1, 2027."

So the home health payment and quality-reporting provisions, and the 484.245 change, take effect Jan. 1, 2027. For everything else, including the enrollment changes, the printed date is "January 4, 2026," which comes before publication. We are quoting it exactly. As of Monday morning we found no correction notice, and we are not substituting a date. Before publication we had counted Jan. 3, 2027, from the public-inspection copy's 60-day language; that count is superseded by whatever CMS prints. Our Nov. 9 checklist covers what else to verify. The enrollment pieces are in our enrollment-changes story and our story on the moratorium rule changes. Year-end dates are in our Q4 deadlines page. For how we tracked the rule through White House review, see our status story. For the July proposal, see our proposed-rule explainer.

Sources

• Federal Register, CMS-1844-F, FR Doc. 2026-22750, 91 FR 72022, Nov. 9, 2026
• GovInfo, official PDF of FR Doc. 2026-22750
• CY 2027 HH PPS final rule, public inspection PDF, FR Doc. 2026-22750
• Federal Register public inspection listing, FR Doc. 2026-22750
• CY 2027 HH PPS proposed rule, 91 FR 41216
• CMS, HH PPS regulations and notices

Sources were opened and checked Nov. 4–5, 2026; the published Federal Register text was opened Nov. 9, 2026. Home Health Brief corrects errors under its published corrections policy.

Photo: Bill Branson, National Cancer Institute, via Wikimedia Commons, public domain (cropped). A clinician takes a patient's blood pressure, November 1990. File photo; illustration only.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards. Read how we use AI, our editorial policy and our corrections policy.