Federal Register #CMS-2026-2311

CMS Proposed Rule: 2027 Home Health Payment System Update and DMEPOS Policy Changes

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) for calendar year 2027. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - Products and Services Requested: - Home health services with updated payment rates, recalibrated case-mix weights, functional impairment levels, comorbidity subgroups, and LUPA thresholds - Expansion of Medicare Part B Durable Medical Equipment (DME) benefit to include certain external infusion pumps and associated home infusion drugs - Home Health Quality Reporting Program (HH QRP) updates, including revised data submission deadlines and reporting timeframes - Provider enrollment services with enhanced requirements and expanded grounds for denial and revocation - DMEPOS Competitive Bidding Program (CBP) country of origin reporting for contract suppliers - OEMs and Vendors: - No specific OEMs or vendors are named in the rule, but the changes directly impact manufacturers and suppliers of DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies), especially those providing external infusion pumps and home infusion drugs - Unique or Notable Requirements: - New requirement for DMEPOS CBP contract suppliers to report country of origin for lead items - Expansion of DME benefit to cover additional infusion pumps and drugs - Enhanced provider enrollment and revocation criteria, including for hospice medical directors and administrators - Temporary payment adjustments to recoup overpayments from previous years - Alignment of quality reporting and value-based purchasing programs - The rule affects home health agencies, DMEPOS suppliers, and related service providers, with significant implications for compliance and reporting.

Description

This proposed rule sets forth routine updates to the Medicare home health payment rates for calendar year 2027 in accordance with statutory and regulatory requirements. It includes adjustments such as behavior adjustment, recalibration of case-mix weights, updates to functional impairment levels, comorbidity subgroups, and low-utilization payment adjustment thresholds. The rule also discusses home health palliative care services, requests information on a home health-specific wage index, and proposes changes to the Home Health Quality Reporting Program and the expanded Home Health Value Based Purchasing Model. Additionally, it clarifies Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) face-to-face encounter requirements, provider and supplier enrollment requirements, DME benefit expansion for infusion pumps and drugs, and information collection regarding the DMEPOS Competitive Bidding Program country of origin.

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