CMS Proposes Updates to Strengthen Medicare Program Integrity, Combat Fraud, and Expand Access to Home Health Care

CMS Proposes Updates to Strengthen Medicare Program Integrity, Combat Fraud, and Expand Access to Home Health Care

The Centers for Medicare & Medicaid Services (CMS) is proposing new safeguards to ensure taxpayers aren't on the hook for noncompliant Medicare providers and suppliers, continuing its campaign to crush fraud, waste, and abuse throughout its programs and hold bad actors accountable. The Calendar Year (CY) 2027 Home Health Prospective Payment System (PPS) proposed rule would strengthen CMS' ability to recover improper payments and remove noncompliant providers and suppliers from Medicare, actions estimated to save approximately $82 million in annual savings, while also expanding access for patients receiving care at home and improving the timeliness of publicly reported home health agency quality information.

"These proposals would give CMS stronger tools to protect Medicare beneficiaries and taxpayer dollars from fraud, waste, and abuse," said CMS Administrator Dr. Mehmet Oz. "The Trump Administration is committed to ensuring only qualified providers and suppliers participate in Medicare while preserving access to high-quality care for patients across the country."

Although included in the CY 2027 Home Health PPS proposed rule, the provider enrollment provisions would apply across Medicare provider and supplier types.

The proposed rule includes new measures that would help CMS recover more taxpayer dollars from noncompliant providers and suppliers. Currently, CMS can claw back payments retroactive to the date of noncompliance for certain Medicare provider enrollment revocation grounds. The proposed rule would make this possible for all Medicare provider enrollment revocations, regardless of the revocation reason. This would allow CMS to recoup additional taxpayer funds and help ensure that noncompliant providers and suppliers are not receiving Medicare payments.

In addition, CMS is proposing to expand the number of reasons for which the agency can take action against problematic providers. These would include, but not be limited to, the following:

• CMS could revoke a provider's or supplier's Medicare enrollment if the enrollment presents a high risk of fraud, waste, and abuse because the provider/supplier is located within a limited geographic area that has an excessive number of providers and suppliers.
• CMS could deny or revoke a provider's or supplier's Medicare enrollment if they have been convicted of a misdemeanor related to sexual assault or financial misconduct within the past 10 years.

The proposed rule also would update Medicare home health payment rates for CY 2027. At the same time CMS is strengthening oversight and crushing fraud, waste, and abuse, the agency is proposing targeted payment updates that support access to care for beneficiaries who rely on home health services. CMS is also proposing to continue to fulfill its statutory obligation to transition the Home Health PPS to the Patient-Driven Groupings Model in a budget-neutral manner. CMS estimates total Medicare payments to home health agencies would increase by approximately 2.4%, or $420 million, compared to CY 2026.

In the proposed rule, CMS is seeking to promote access to and use of community-based palliative care services. CMS believes the Medicare home health benefit can be an important step in the care continuum when a patient needs palliative care, either during episodes of serious illness or near end of life. Therefore, in this proposed rule, CMS states that skilled palliative care services can be furnished and billed under existing Medicare home health benefits for eligible patients with serious illnesses. The agency emphasizes that palliative care under the home health benefit is separate from hospice care and may support patients earlier in the course of serious illness. CMS plans on adding additional palliative care examples of skilled care through sub-regulatory guidance following the publication of the CY 2027 HH PPS final rule to support its goal of encouraging community-based palliative care services, particularly under the Medicare home health benefit.

To improve transparency for patients and families, CMS also is proposing to shorten the Outcome and Assessment Information Set data submission deadline from 4.5 months to 45 days, giving people with Medicare more timely information to make informed care decisions. CMS estimates the proposal could make publicly reported quality information available up to three months sooner.

Additional proposals include updates related to durable medical equipment, prosthetics, orthotics, and supplies, the home health quality reporting program, hospices, and the Medicare provider enrollment process.

To view a fact sheet on the proposed rule, visit: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2027-home-health-prospective-payment-system-proposed-rule-fact-sheet-cms-1844-p .

The proposed rule can be viewed on the Federal Register at: https://www.federalregister.gov/d/2026-13602 .

Additional information on the Medicare Home Health PPS can be viewed at: https://www.cms.gov/medicare/payment/prospective-payment-systems/home-health and https://www.cms.gov/hha-information-center .

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