2027 Home Health Final Rule: What Changed From the Proposal

What did CMS finalize in the 2027 home health final rule?

CMS issued the CY 2027 home health final rule, CMS-1844-F, on November 4, 2026, and estimates it raises Medicare payments to home health agencies by 2.4% in aggregate, about $415 million, compared with CY 2026¹. The payment provisions take effect January 1, 2027².

That 2.4% has two parts: the 2.1% payment update, worth $365 million, and an estimated 0.3% from the updated fixed-dollar loss (FDL) amount, worth $50 million¹. The -3.0% temporary adjustment stays on the rate, but it adds nothing to the year-over-year change because the CY 2026 rate carried the same cut².

The enrollment provisions run on a different clock. They take effect 60 days after the rule was filed for public inspection, not on January 1².

What changed between the July proposal and the final rule?

Less than the headlines suggest. The proposal estimated 2.4%, or $420 million, with a 2.1% update worth $370 million⁴. The final keeps both percentages and trims each dollar figure by $5 million^1,4. The proposed rule post walks through the July figures in full.

What are the 2027 30-day base rate and LUPA per-visit rates?

The national, standardized 30-day period payment for CY 2027 is $2,092.69 for agencies that submit the required quality data and $2,051.70 for agencies that don’t². Those are national figures before case-mix and wage adjustment, so no claim pays exactly that amount.

CMS took the CY 2026 rate without the temporary adjustment, $2,101.26, applied budget neutrality factors of 1.0047 for case mix and 1.0009 for wage index and the 1.0210 update to reach $2,157.41, then the 0.9700 temporary adjustment factor². The wage index adjusts the labor-related share, still 74.9%².

LUPA periods pay per visit, and the per-visit amounts carry neither the permanent nor the temporary adjustment². For agencies that submit quality data, the 2027 national per-visit amounts are²:

• Home health aide: $81.79
• Medical social services: $289.57
• Occupational therapy: $198.81
• Physical therapy: $197.46
• Skilled nursing: $180.66
• Speech-language pathology: $214.64

How do the LUPA and outlier changes reach your claims?

Through two thresholds. A period that doesn’t reach its payment group’s visit threshold is paid per visit instead of the full case-mix adjusted rate; with a threshold of four, a period with three visits pays per visit². The proposal would have lowered the threshold by one visit in 18 groups. With more complete CY 2025 claims data, the final lowers it in 10 groups and raises it in one².

So a period that sat one visit short in one of those ten groups now pays the full rate, and the one group that went up does the reverse. Your LUPA report needs the 2027 table, keyed by HIPPS code, before the first January claim goes out.

Outliers loosen. A period’s outlier threshold is its case-mix and wage adjusted payment plus an FDL amount, which is the FDL ratio multiplied by the wage-adjusted national rate². CMS says a lower ratio means more periods can qualify². The PDGM case-mix weights, functional levels and comorbidity subgroups were also recalibrated with CY 2025 data, so expected payment by group shifts even where a threshold didn’t¹.

Which enrollment and fraud provisions did CMS finalize?

Most of what it proposed, and they reach well beyond home health. The enrollment provisions apply to all Medicare provider and supplier types unless the rule says otherwise², and CMS expects them to save about $82 million a year¹. What’s final²:

• Every revocation ground is retroactive to the date noncompliance began, instead of taking effect 30 days after the notice is mailed.
• A revoked provider has 15 calendar days from the date of the revocation letter to submit its remaining claims. The old rule gave 60 days.
• New denial and revocation grounds cover misdemeanor convictions for sexual assault or financial misconduct within the past 10 years, and enrollments in small areas with a concentration of providers CMS treats as a high fraud risk^2,3.
• License and program suspensions involving owners, managing employees or managing organizations become a denial ground.
• A home health agency, hospice or DMEPOS supplier that ignores the change in majority ownership rules can be denied or revoked.
• A reapplication bar of up to 10 years can follow any denial, not only one for false information.

One proposal didn’t survive: CMS dropped its plan to let a denied application trigger revocation of a provider’s other enrollments².

The 15-day window is the one to plan around. Commenters told CMS that agencies with monthly billing cycles and notice of admission requirements couldn’t file everything in 15 days, and CMS finalized it anyway². The answer is a claim queue that never runs more than a cycle behind, which is daily work in Medicare billing. The enrollment changes post covers the PECOS records behind the ownership rules.

Which rates pay a 30-day period that spans January 1?

The 2027 rates, if the period ends in 2027. CMS states that the end date of the 30-day period, as reported on the claim, determines which calendar year rates Medicare uses².

The NOA rules don’t change at year end. An agency submits one notice of admission within 5 calendar days from the start of care, and that NOA covers contiguous periods until discharge⁵. A late NOA cuts the payment by 1/30th of the wage-adjusted 30-day amount for each day from start of care to submission, and Medicare won’t make LUPA per-visit payments for days before the NOA went in⁵. Holiday staffing is the risk, not the rule.

What to do this week

1. Load the 2027 national rate, the per-visit amounts and the final case-mix weight and LUPA threshold file into your expected-payment tables^1,2.
2. Pull December admissions and confirm each NOA went in within 5 calendar days of start of care⁵.
3. Flag every period that starts in December and ends in January as a 2027 period in the variance report².
4. Work the claim queue down so nothing sits longer than one billing cycle, given the 15-day window after a revocation letter².
5. Check your counties in the CY 2027 wage index file for transition codes that changed².