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Forty-three states and DC must impose an 80-hour monthly work requirement by January 1, 2027. The medical frailty exemption is where home care lives, and your claims may be the proof.

Medicare effectively paid low-visit hospices $573 per routine home care visit versus $232 at high-visit hospices. What GAO-26-107585 found and how to measure your own visit intensity.

Home health agencies were named in nearly 32% of the health care fraud reports banks filed with FinCEN, more than any other provider type. What banks flag, and how clean books avoid it.

CMS posted Annual QAO performance reports on September 18, 2026. Below 90% means a 2-point cut to your Medicare update, and older OASIS assessments are rejected after December 31.

California, Colorado and Michigan have published January 1, 2027 minimum wages. New York, the state with the highest home care aide floor, has not. What that means for margins.

CMS recalibrated all 432 PDGM case-mix weights and LUPA thresholds for CY 2026, and OASIS-E2 took effect April 1. Where the dollars leak, and what CY 2027 adds.

CMS reports 20.37% of hospices failed quality reporting for FY 2026, each losing four points off the annual payment update. Where HOPE stands and what the FY 2027 final rule settled.

The CERT improper payment rate for home health is 7.7%. When OIG audited one agency this summer, 37 of 100 sampled claims were in error. How extrapolation turns $8,332 into $43,074.

Every Medicare-certified home health agency carries a -5% to +5% adjustment on every claim, decided by performance delivered two years earlier. The measure weights and the report calendar.

Midyear projections put 2026 hospice transaction volume at 44 deals — a post-COVID high. What buyers are underwriting now, and how the enrollment moratorium limits deal structure.

The nationwide freeze on new Medicare home health and hospice enrollment hits six months on November 13, 2026. The dates, the CHOW trap, and what to do before then.

CMS sent its proposed CRUSH rule to OMB on August 7, 2026. What the AI models flag in hospice claims, and how to prepare for a pre-payment review you won't be warned about.

CMS delayed two Access Rule provisions in 2026 but not the 80% pass-through. The real timeline to 2030, and what a shrinking Medicaid census does to your 20%.

CMS's FY 2024 RCD data: 97% of pre-claim requests affirmed, a 3.5% denial rate, and 51.6% of appeals overturned — but only 7% of denials were ever appealed.

As of the FY 2027 final rule, the hospice election-statement addendum is mandatory for every patient who elects hospice — not just those who ask for it (CMS-1851-F). The addendum is the written list of conditions, items, services, and drugs the hospice has determined are unrelated to the terminal illness and therefore not covered under the hospice benefit. CMS made it mandatory because non-hospice spending kept climbing, and it now sits alongside the new SSVI integrity score

A single late or unsupported home health cost report can convert a full year of interim Medicare payments into a recoverable overpayment (42 CFR 413.20; CMS Provider Reimbursement Manual). With freestanding agencies posting a 21.2% FFS Medicare margin in 2024 and MedPAC pressing for rate cuts, CMS and its contractors are scrutinizing agency cost data more closely than ever. The good news: cost report audits are predictable, and agencies that treat documentation as a year-roun

Every Medicare hospice now has a public integrity score. In the FY 2027 final rule, CMS finalized the Service and Spending Variation Index (SSVI) — a nine-measure score, built from FY 2024 and FY 2025 claims, that flags hospices with concerning utilization and non-hospice spending (CMS-1851-F). It is CMS's most direct response yet to fraud, waste, and abuse in hospice, and it puts provider-level data in the open. If you run a hospice, understanding your SSVI score — and what

About 28% of hospices exceeded the Medicare aggregate cap in 2023, each owing back roughly $410,000 on average (MedPAC, March 2026). The cap is the single largest financial risk in hospice — a hard ceiling on how much Medicare will pay a hospice per beneficiary per year, and any dollar above it must be repaid. For the FY 2027 cap year (October 1, 2026 - September 30, 2027) the cap is $36,174.75 per beneficiary (CMS-1851-F). Here is how the cap works, how it is calculated, and

The average freestanding home health agency earned a 21.2% FFS Medicare margin in 2024 while delivering just 8.4 in-person visits per 30-day period — down 18% from 2019 (MedPAC, March 2026). Those two numbers tell the whole story of home health economics right now: strong Medicare margins, achieved partly by delivering fewer visits. If you run an agency, benchmarking your own numbers against the national data is the fastest way to see whether you're leaving money on the table

Home health agencies would see a net 2.4% Medicare payment increase — about $420 million — in calendar year 2027 under the proposed rule CMS issued on July 1, 2026 (CMS, CY 2027 HH PPS Proposed Rule, CMS-1844-P). After a 1.3% cut in 2026, that is the first proposed raise in the PDGM era — but the relief is partial: CMS proposes to keep the -3.0% temporary "clawback" adjustment in place while, for the first time, proposing no additional permanent behavioral cut. Layered on top