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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

Even with a proposed 2.4% raise for 2027, CMS is keeping a -3.0% "temporary" adjustment in place to claw back what it calls billions in PDGM-era overpayments (CMS-1844-P). The headline increase and the clawback are two different things, and agencies that only read the headline are in for a cash-flow surprise. CMS's cumulative temporary-adjustment estimate has reached roughly $4.9 billion through CY 2025, and the recoupment is being spread across "one or more" years — meaning

Since 2020, Medicare has paid home health in 30-day periods instead of 60-day episodes — and a single late Notice of Admission now cuts a period's payment by 1/30 for every day it is late (CMS, MM12256; 42 CFR 484.205). The Patient-Driven Groupings Model (PDGM) didn't just change how much agencies are paid; it changed when, and it punishes billing delays harder than the old system ever did. For agency owners, cash flow now lives and dies on the NOA clock and the LUPA threshol

Hospices will receive a 2.3% Medicare payment increase — about $755 million — in fiscal year 2027, and the aggregate cap rises to $36,174.75, under the final rule CMS issued July 30, 2026 (CMS, FY 2027 Hospice Final Rule, CMS-1851-F). Unlike the home health proposed rule, this one is final and effective October 1, 2026. And the rate update is the least of it: CMS finalized a new Service and Spending Variation Index (SSVI) that publishes a program-integrity score for every hos

Aveanna Healthcare’s second-quarter revenue beat puts demand, labor costs, reimbursement, margins, and outlook under investor scrutiny, with practical accounting lessons for home-based care providers.

Alignment Healthcare shares dropped 16.7% after whistleblower accounting allegations triggered a securities investigation, raising questions about expense classification and Adjusted EBITDA.

MaineCare suspended payments to Community Home Health Care after allegations of billing for services not provided. The provider received nearly $48 million from 2019 through 2025 but remains licensed.

Nova Leap Health reported record second-quarter 2026 revenue, operating income and Adjusted EBITDA, supported by acquisitions and expansion across North America.

Pennant’s quarterly growth, led by home health and hospice operations, highlights financial and operational lessons for Chicagoland care providers.

A new home care survey identifies compliance, scheduling and billing as leading technology priorities while highlighting growing AI use and the need for stronger financial data practices.

A New York investigation examines $733 million in Medicaid billing by Flushing social adult day-care centers, alleged kickbacks, oversight failures, and compliance lessons for healthcare providers.

Nova Leap Health reports record Q2 2026 revenue, operating income, and adjusted EBITDA while expanding through acquisitions and new care offices.

Pennant’s Q2 2026 revenue rose 35.8% as home health and hospice growth drove earnings, margins, and an upgraded full-year outlook.