CY 2027 Home Health Final Rule: What Changed From the Proposal

CMS released the CY 2027 home health final rule on November 4, 2026. It finalizes a 2.4% increase in total Medicare home health payments for 2027, about $415 million: the 2.1% payment update plus 0.3% from a lower outlier threshold. The 3.0% temporary cut stays on the 30-day rate for a second year, and there is no new permanent cut. The national 30-day rate is $2,092.69 from January 1, 2027.

Almost all of it was finalized as proposed. On newer claims data, the dollar total fell from $420 million to $415 million, the permanent cut CMS calculated and chose not to take shrank from −5.043% to −4.777%, the comorbidity lists grew, and 12 LUPA thresholds differ between the proposed and final files, one of them a correction. Below are the proposed-versus-final table, the 2027 LUPA thresholds and weights from CMS's own files, what else the rule finalized, and what to do before January 1.

Source: CY 2027 Home Health Prospective Payment System Rate Update final rule (CMS-1844-F), Federal Register document 2026-22750, filed for public inspection November 4, 2026 and published in the Federal Register on November 9, 2026 at 91 FR 72022 (opens in a new tab). Page numbers below are pages of the public-inspection version (opens in a new tab) (447 pages). LUPA thresholds and case-mix weights come from the CMS data files listed under Sources.

Proposed vs. Final

The payment update did not move because the forecast did not: IHS Global's third-quarter 2026 forecast still puts the market basket at 3.1% and productivity at 1.0 point (pp. 89 to 90). Agencies that do not submit the required quality data get 0.1%, which puts their national 30-day rate at $2,051.70 (Table 14, p. 106).

CMS kept the temporary cut over objections. Commenters asked it not to finalize the −3.0%, and CMS declined, saying "applying a temporary adjustment in CY 2027 mitigates the need for a larger temporary adjustment in the future" (p. 43). It still expects to collect about $500 million in 2027, roughly a tenth of the balance, and it says again that it "may propose additional temporary adjustments in future rulemaking" (pp. 32 to 33). What the −3.0% costs an agency of your size, in dollars, is worked out in Medicare cuts in 2027.

The 2027 Rates

Tables 12, 13 and 15 of the final rule (pp. 104 to 108). The per-visit rates pay LUPA periods and carry neither the permanent nor the temporary adjustment (p. 107).

The 30-day rate rises 2.7%, more than the 2.1% update. That is not extra money. CMS multiplies the rate by a case-mix budget neutrality factor of 1.0047 so that the new weights, which pay slightly less on 2025's mix of patients, pay the same total as the old ones (pp. 79 and 104), and by a wage index budget neutrality factor of 1.0009 (p. 105). The LUPA add-on factors are 1.7200 for skilled nursing, 1.6225 for physical therapy, 1.6696 for speech-language pathology and 1.7238 for occupational therapy (Table 17, p. 111).

LUPA Thresholds: 2026 vs. 2027

CMS recalibrated the LUPA thresholds on 2025 claims. Comparing CMS's CY 2026 and CY 2027 files row by row, 38 of the 432 payment groups have a different threshold in 2027, each by one visit: 23 lower, 15 higher. A 30-day period with fewer visits than its group's threshold is paid per visit as a LUPA.

From CMS's CY 2026 and CY 2027 Final HH PDGM Case Mix Weights and LUPA Thresholds files. The 2027 values match Table 11 of the final rule (pp. 69 to 78) for all 432 groups.

Where a threshold went up, a period needs one more visit to be paid as a full 30-day period: 1AB31 now needs 4 visits instead of 3. Where it went down, one fewer visit clears it.

Two notes on CMS's own account of this. The rule's preamble describes the final update as 10 groups one visit lower and one group one visit higher (pp. 46 to 49). Those counts match the difference between CMS's proposed and final files. They do not match a row-by-row comparison of the CY 2026 and CY 2027 files, which is what the table above shows. And the proposed file listed 4LC11 at 3.5 visits; CMS calls that "an inadvertent technical error" and sets it at 3 (p. 47).

The LUPA threshold checker reads CMS's CY 2026 file, which applies to periods that end in 2026. For periods that end in 2027, use the table above.

Case-Mix Weights: Who Gained and Who Lost

Every one of the 432 weights changed: 203 went up and 229 went down. Wound took the largest cut. All 36 Wound codes lost weight, and the 20 codes that lost the most are all Wound. MMTA: Endocrine gained the most on average. Commenters said the same about the proposal, and CMS answered that the high-acuity groups "remain among the highest weighted" categories, citing a 2027 weight of 1.9221 for the top Wound group (pp. 79 to 80).

Lost the most weight

Gained the most weight

Average weight by clinical group (simple average of each group's 36 HIPPS codes, not weighted by how often each code is billed)

A weight is only half the payment. Multiply it by its year's rate to compare dollars, before the wage index: 1CA11 pays $2,725.71 in 2026 (1.3373 × $2,038.22) and $2,679.27 in 2027 (1.2803 × $2,092.69), down $46.44 even after the rate increase. 3IC31 goes from $2,410.40 to $2,534.88. Look up any code in the HIPPS decoder.

What Else CMS Finalized

The OASIS deadline. As proposed: OASIS submissions and corrections are due by the 15th day of the second month after the end of each quarter, starting with CY 2027 data. Table 19 sets May 17, August 16 and November 15, 2027, and February 15, 2028 (p. 137). Commenters asked for a phased start or a grace period; CMS said a phased implementation is not necessary (pp. 138 to 139). Detail in the OASIS submission deadline is moving.

Calendar-year reporting. As proposed: OASIS data from July 1 to December 31, 2026 sets the 2028 annual payment update, and calendar year 2027 sets 2029 (Table 20, p. 142). For HHCAHPS, April 1 to December 31, 2026 sets 2028 (Table 21, p. 145).

Functional points. Identical to the proposal. M1860 response 3 is now worth 0 points; commenters objected, and CMS declined to set a floor or freeze point values for several years (pp. 51 to 54). Detail in PDGM functional points for 2027.

Palliative care. No new benefit and no new payment. CMS says agencies may furnish palliative care "as a component of a skilled service already covered under the home health benefit," that these services can be applied across all home health disciplines rather than only under the MMTA grouping the proposal pointed to, and that it will add palliative care examples to the Medicare Benefit Policy Manual and issue matching instructions to the MACs (pp. 126 to 128). Detail in palliative care under the home health benefit.

The wage index. CY 2027 keeps the FY 2027 pre-floor, pre-reclassified hospital wage index with the 5% cap on decreases (p. 101). CMS summarized the comments on a home health specific wage index and said it "will not be responding to specific comments" in this rule (p. 130). Detail in the wage index request for information.

Provider enrollment. Most of it finalized without modification. For agencies, the parts that matter:

• CMS may deny or revoke enrollment if an agency does not comply with the 36-month rule on changes in majority ownership (42 CFR 424.550(b)). CMS names two ways it has seen the rule avoided: not telling CMS about a sale, and a management agreement that hands over control now with the sale timed for after the 36 months (pp. 249 to 254). Detail in buying a home health agency.
• The revocation grounds that were still prospective become retroactive, so a revocation can take effect from the date the non-compliance began (pp. 180 and 203).
• A revoked agency has 15 calendar days from the date of the revocation letter to submit its claims, down from 60 days (pp. 204 to 208).
• A moratorium now starts on the day its notice is filed for public inspection, and reactivations and ownership changes that require an initial enrollment count as new enrollments under it (pp. 259 to 265).
• Every enrolled provider must post a visible sign with its hours. One exception covers a provider that "treats patients in the patients' homes"; commenters asked for an explicit exception for agencies, and CMS declined to add provider-type exceptions in this rule (pp. 295 to 298).

CMS dropped some enrollment proposals, among them revoking a provider's other enrollments after one is denied (p. 179).

DME. Certain external infusion pumps and home infusion drugs are covered as DME for items furnished on or after April 1, 2027, with the drug infused "at least 12 times per year" rather than the proposed once a month (pp. 341 to 353). No new face-to-face encounter is needed to replace a DMEPOS item under the same HCPCS code (p. 4).

What To Do Before January 1

1. Get the 2027 tables into billing. Your billing system needs the 2027 rates, weights and LUPA thresholds. The end date of the 30-day period on the claim decides which year's rates pay it (p. 103), so a period that starts in December and ends in January is paid at 2027 rates. CMS says the January grouper is available for beta testing about 6 to 8 weeks before it takes effect (p. 48). Ask your vendor when it loads.
2. Check the 38 groups whose LUPA threshold moved. If your schedule targets a visit count per period, the 15 groups that went up need one more visit in 2027.
3. Budget on your own number, not 2.4%. CMS projects 3.0% for agencies with fewer than 100 periods and 2.3% for 1,000 or more, and by region from 1.6% (East South Central) to 3.6% (Mid-Atlantic and outlying areas) (Table 23, pp. 382 to 383). Your wage index and case mix move it further.
4. Close the six-month OASIS transition at 90% or better. July 1 to December 31, 2026 sets your 2028 update, and missing the threshold takes 2 percentage points off it. This year, that is the difference between 2.1% and 0.1%.
5. Move OASIS corrections inside 45 days of quarter end. The first deadline under the new rule is May 17, 2027.
6. If you are buying, selling or managing an agency, read the ownership changes before you sign a management agreement.

Related on This Site

• CMS-1844 on the Home Health Rule Tracker: the proposed and final rule, with their Federal Register records.
• CY 2027 proposed rule: what actually changes: the payment arithmetic as proposed, and the $4.9 billion.
• Medicare cuts in 2027: the 2% sequester, PAYGO, and the −3.0% in dollars for an agency.
• LUPA threshold checker and HIPPS decoder.

Frequently Asked Questions

What does the CY 2027 home health final rule do?

It raises total Medicare home health payments for 2027 by an estimated 2.4 percent, about $415 million: a 2.1 percent payment update plus 0.3 percent from a lower outlier threshold. It keeps the 3.0 percent temporary cut that 2026 rates already carry, adds no new permanent cut, and recalibrates the case-mix weights and LUPA thresholds on 2025 claims. CMS released it on November 4, 2026 as CMS-1844-F.

When does the CY 2027 home health final rule take effect?

The payment and quality reporting provisions take effect January 1, 2027, and the end date of a 30-day period on the claim decides which year's rates pay it. Most other provisions, including the provider enrollment changes, take effect January 4, 2027. The published rule prints that date as January 4, 2026, a misprint for 2027.

Did CMS keep the 3 percent home health cut for 2027?

Yes. CMS finalized the 3.0 percent temporary reduction to the 2027 30-day rate as proposed. The 2026 rate carries the same 3.0 percent, so it does not lower total payments compared with 2026, but it keeps the national 30-day rate at $2,092.69 instead of $2,157.41. LUPA per-visit rates do not carry it.

Did the LUPA thresholds change for 2027?

Yes, for 38 of the 432 payment groups, each by one visit: 23 went down and 15 went up, comparing CMS's CY 2026 and CY 2027 files row by row. The other 394 groups keep their 2026 threshold.

Sources

• CMS, CY 2027 Home Health Prospective Payment System Rate Update final rule (CMS-1844-F), Federal Register document 2026-22750: public-inspection PDF (opens in a new tab), 447 pages, filed November 4, 2026, published November 9, 2026 at 91 FR 72022 to 72173 (Federal Register page (opens in a new tab)). Read November 7, 2026. Every page number above refers to this version.
• CMS, CMS-1844-F on the HH PPS Regulations and Notices page (opens in a new tab), display date November 4, 2026, with the rule's data files.
• CMS, CY 2027 Final HH PDGM Case Mix Weights and LUPA Thresholds, cy-2027-final-hh-pdgm-case-mix-weights-lupa-thresholds.zip (opens in a new tab), file read: "508_Compliant_Version_of_HH_PDGM Case Mix Weights.csv" (432 payment groups). Downloaded November 7, 2026. Every 2027 weight and LUPA threshold above.
• CMS, CY 2026 Final HH PDGM Case Mix Weights and LUPA Thresholds, cy2026-hh-pdgm-case-mix-weights-lupa-thresholds.zip (opens in a new tab), file read: "508 Version of CY 2026 Final HH PDGM Case Mix Weights and LUPA Thresholds.csv". Downloaded November 7, 2026. Every 2026 weight and LUPA threshold above.
• CMS, CY 2027 Proposed HH PDGM Case-Mix Weights and LUPA Thresholds, cy-2027-proposed-hh-pdgm-case-mix-weights-lupa-thresholds.zip (opens in a new tab), file read: "508 Version CY 2027 Proposed HH PDGM Case-Mix Weights and LUPA Thresholds.csv". The proposed-to-final LUPA comparison.
• CMS, CY 2027 Home Health Prospective Payment System Final Rule fact sheet (opens in a new tab), November 4, 2026. Its heading reads "CMS-1844-P"; the rule it describes is CMS-1844-F.
• CMS, CY 2027 HH PPS proposed rule (CMS-1844-P), 91 FR 41216, July 6, 2026, document 2026-13602 (opens in a new tab). The proposed rates, functional tables and impact figures in the first table are from its public-inspection version (opens in a new tab) (Tables 16, 18, 19, 20, 26, 28 and 36).