The rule also expands CMS’s authority to revoke provider enrollment and recover improper payments.
According to the Centers for Medicare and Medicaid Services, the increase includes a 2.1% payment update and a 0.3% increase associated with revisions to outlier payments. The agency is also continuing to recover what it considers excess payments made from 2020 through 2025 after Medicare adopted the Patient-Driven Groupings Model and replaced 60-day home-health payment periods with 30-day periods.
The rule also strengthens Medicare enrollment enforcement across provider and supplier types and estimates the enrollment changes will save taxpayers approximately $82 million annually.
New Enforcement Actions
- CMS may make enrollment revocations retroactive to the date noncompliance began, allowing the agency to recover payments made after that date.
- Home-health agencies, hospices and DMEPOS suppliers undergoing certain changes in majority ownership must reenroll as new Medicare providers and complete a new survey or accreditation.
- CMS may deny or revoke enrollment based on license or program sanctions affecting an organization’s owners or managing employees.
The agency also confirmed that palliative care may be furnished through the Medicare home-health benefit for beneficiaries with serious or progressive illnesses. CMS plans to provide examples of covered palliative services through future guidance. The new rule provides expanded coverage of certain external infusion pumps and associated home-infusion drugs beginning April 1.
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