Home Health's $4.9 Billion Still Has No Due Date
CMS told home health agencies last December it would consider a schedule for collecting the PDGM balance. The CY 2027 proposed rule prices that balance at $4,908,531,936, proposes a second straight year of 3 percent, and says it is not establishing a timeframe. Comments close August 31.
Medicare's home health program runs a tab, and the CY 2027 proposed rule prices it at $4,908,531,936.
That is what CMS says it overpaid home health agencies on claims from CY 2020 through CY 2025, under the assumed-versus-actual behavior test Congress attached to the Patient-Driven Groupings Model in section 1895(b)(3)(D) of the Act. The figure appears once, in Table 18 of a 269-page rule, and the Federal Register renders that table as an image. It is not in the fact sheet, and we could not find it in any summary of the rule.
The number that made the summaries is +2.4%.
The accrual is nearly closed
Table 18 splits the balance by claims year, and the shape is the part worth having (chart below).
CY 2022 was the peak at $1.41 billion. CY 2025 added $152.4 million, down about 89% from that peak, and the first three years carry 71% of the whole balance.
That tracks the fix CMS already applied. Permanent adjustments of -3.925% in CY 2023, -2.890% in CY 2024, -1.975% in CY 2025 and -1.023% in CY 2026 walked the base rate down, and the rule says it plainly: the 30-day rate "was not budget neutral until the CY 2026 payment rate."
So the leak is closed. The bucket is still full.
The rest of this brief is for subscribers.
The impact tables, the code-level detail, and the rest of the analysis sit past this line.
$50 a month, or $500 a year.
Already a subscriber? Sign in