Federal Register #2026-13602

CMS Proposed Rule: 2027 Medicare Home Health Payment and DMEPOS Policy Updates

This opportunity involves a proposed rule from the Centers for Medicare & Medicaid Services (CMS) to update the Medicare Home Health Prospective Payment System (HH PPS) and related DMEPOS policies for 2027. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - Products and Services Requested: - Home health services payment rate updates, including recalibration of case-mix weights, LUPA thresholds, functional impairment levels, and comorbidity subgroups - Expansion of Medicare Part B DME benefit to include certain external infusion pumps and associated home infusion drugs - Home Health Quality Reporting Program (HH QRP) changes, including revised data submission deadlines and reporting timeframes - Provider enrollment process enhancements, including expanded denial/revocation grounds and new requirements for hospice medical directors and administrators - DMEPOS Competitive Bidding Program requirement for contract suppliers to report country of origin for lead items - OEMs and Vendors: - No specific OEMs or vendors are named in the proposed rule - Impacts manufacturers and suppliers of home health services, external infusion pumps, and DMEPOS items - Unique or Notable Requirements: - DMEPOS suppliers must report country of origin for lead items - Expansion of DME benefit to cover external infusion pumps and home infusion drugs - Temporary payment adjustments to recoup overpayments from previous years - Strengthened provider enrollment and accreditation requirements - Alignment of reporting timeframes with payment policies for improved timeliness

Description

This proposed rule sets forth routine updates to the Medicare home health payment rates for calendar year 2027, including adjustments to behavior, case-mix weights, functional impairment levels, comorbidity subgroups, and low-utilization payment adjustment thresholds. It discusses the provision of home health palliative care services and requests information on a home health specific wage index. The rule also proposes changes to the Home Health Quality Reporting Program and clarifies Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) face-to-face encounter requirements for replacement items. Additionally, it addresses Medicare provider enrollment, DME benefit expansion, and collection of country of origin information for DMEPOS Competitive Bidding Program contract suppliers.

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