The Centers for Medicare & Medicaid Services (CMS) has issued the proposed Calendar Year (CY) 2027 Home Health Prospective Payment System (PPS) Rule. While the rule primarily addresses Medicare home health payment policies, it also includes proposed Medicare provider enrollment changes that would apply across Medicare provider and supplier types, including nursing facilities.
With respect to program integrity, the proposed rule includes new measures intended to strengthen CMS's ability to recover improper Medicare payments and take enforcement action against noncompliant providers and suppliers, including:
- Retroactive Revocations – Under current regulations, certain Medicare enrollment revocations become effective prospectively – specifically, 30 days after the date that CMS or the CMS contractor mails notice of the revocation to the affected provider or supplier. However, other revocations take effect retroactively to the date the provider’s noncompliance began. The agency is proposing to make all revocation grounds retroactive.
- Adding or Expanding Bases for Revocation or Denial – CMS is proposing to add several new grounds for revocation or denial of enrollment and to expand some of our existing grounds. Among these proposals are the following:
- Change in Majority Ownership – Hospices; HHAs; and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must reenroll in Medicare as a new provider and undergo a survey/accreditation if they experience certain changes in majority ownership. CMS proposes to deny or revoke enrollment if this requirement is violated.
- Program or License Suspension/Termination – CMS currently may deny or revoke enrollment if a provider: (1) has a suspended/revoked license in another state; or (2) is suspended/revoked from Medicaid or another federal healthcare program. The agency proposes expanding this to include similar suspensions/revocations involving the provider’s owners or managing employees/organizations.
CMS is accepting public comments on the proposed rule before issuing a final rule. To view a fact sheet on the proposed rule, click here.