Downcoded
October 13, 20265 min readSubscribers

How Late Can Your 2027 Rate Book Legally Be?

Four CY 2027 payment final rules are still at OMB and CMS has not published a document since October 9. The statute everyone quotes at 60 days sets the comment period, not the effective date; the provision that governs the gap is 30 days, which makes December 2 the last date a rate book can publish and still bite on January 1. Last year CMS published the home health rule on exactly that date. Also in the window: three October 8 transmittals nobody has worked, a DMEPOS document clock that opened a week ago, and a commercial side quieter than CMS.

If you are costing out 2027 this week, you are doing it without a rate book. Four sit at OMB and not one has published.

We said as much on Sunday, and so did everybody else. The part nobody puts a date on is the floor underneath it.

How late can a payment rule be and still take effect January 1? Medicare's own statute answers that, and the answer is December 2.

The thirty days nobody quotes

The number people reach for is 60 days, and it is in the statute. It is the comment period: section 1871(b)(1) requires "not less than 60 days for public comment" before a final regulation issues, and says nothing about when that regulation starts costing money.

The provision that governs the gap is 1871(e)(1)(B)(i), and it is shorter. A substantive change "shall not become effective before the end of the 30-day period that begins on the date that the Secretary has issued or published, as the case may be, the substantive change."

Thirty days. Counted back from January 1, 2027, the last workable publication date is December 2, 2026, which is 50 days from this morning.

Clause (ii) lets CMS go earlier, on a published finding that the 30 days would be contrary to the public interest or inconsistent with a statutory requirement. The finding has to print inside the rule.

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.

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