How does the HHCAHPS patient survey work for your agency in 2027?

One count decides it: unduplicated survey-eligible patients served in a 12-month reference period. At 60 or more, you participate. At 59 or fewer, you can be exempted, but only if you file a Participation Exemption Request form on the HHCAHPS website, again every year. For the 2028 payment year the reference period is April 1, 2025 to March 31, 2026, and the form is open now. An agency certified on or after April 1, 2026 is too new to take part for 2028 and doesn't need to apply.

Under CMS's protocols manual, a patient is survey-eligible for a month if they:

• are 18 or older by the end of the month
• had care paid by Medicare or Medicaid, including Medicare Advantage and Medicaid managed care
• had at least one skilled visit (nursing, PT, OT or speech) that month, and at least two across that month and the one before
• are alive and not in hospice
• weren't seen only for routine maternity care

Leave off patients who asked you not to release their name, who harmed or tried to harm staff (document why), or whose state law restricts releasing their information.

The CY 2027 final rule, issued November 4, 2026, moves the survey months that count from April through March to the calendar year, with a nine-month bridge:

CMS promised transition guidance; as of November 7 the HHCAHPS website hasn't posted any.

The website asks vendors to submit by the Monday before each Thursday deadline. The Data Center, the HHCAHPS site where vendors upload your data, takes nothing after a deadline, and the agency guide says "There are no extensions given if a vendor does not successfully submit the HHA's data by each deadline."

Since the April 2026 sample month, your patients get a shorter survey: 25 questions instead of 34. It now asks whether staff cared about the patient as a person, whether the services helped them take care of their health, and whether staff kept family or friends informed as much as the patient wanted. Home safety, reviewing medicines and medicine side effects each became a measure of their own.

For you, that means a gap in public scores. Care Compare, Medicare's public comparison site, isn't expected to show the rewritten measures until October 2027, using April 2026 to March 2027 answers, under the CY 2026 final rule. Until then your scores on them show only in your private preview reports from CMS. Your patient survey star is built from these answers.

The survey comes in English, Spanish, Simplified and Traditional Chinese, Russian, Vietnamese and Armenian; agencies and vendors may not translate it further.

You can only use a vendor on CMS's approved list, 23 names as of February 12, 2026. CMS doesn't rank them. The regulation bars any organization that "owns, operates, or provides staffing for an HHA" from surveying its own patients or any other agency's.

On the HHCAHPS website, register as your agency's Survey Administrator, name a backup, and authorize your vendor for each CMS Certification Number (CCN). The Data Center rejects data from a vendor you haven't authorized, and you can authorize only one at a time.

The manual lets you tell patients at their next scheduled assessment that they may be asked to respond to a patient experience survey, "as long as all patients are notified in this way," and CMS encourages the official fact sheet, with your logo if you like, in the start-of-care packet.

The manual lists what is "not acceptable." In its words, an agency may not:

• "Attempt to influence their patients' answers to the HHCAHPS Survey questions"
• "Tell the patients that the agency hopes or expects that its patients will give it the best or highest rating or to respond in a certain way to the survey questions"
• "Offer incentives of any kind to the patients for participating (or not) in the survey"
• "Help the patient answer the survey questions, even if the patient asks for the home care provider's help"
• "Ask patients why they gave a certain response or rating to any of the HHCAHPS Survey questions"
• "Mail or email information to a subset of patients in advance alerting them about the survey, other than the information provided to all patients"

The agency guide adds that you "cannot publicize or distribute (in any way) HHCAHPS data or comments, even if it is de-identified," on your website, brochures and social media included.

Miss the quality reporting requirement, HHCAHPS included, and that year's payment update, Medicare's yearly inflation raise to your rates, drops by 2 percentage points: for 2027, 0.1% instead of 2.1%. The national 30-day base rate is $2,092.69 for agencies that reported and $2,051.70 for those that didn't, $40.99 less on every 30-day period before wage and case-mix adjustments. By our arithmetic, that's about 2% less per period, for every traditional Medicare period you bill that year. The regulation applies the cut to that year only.

You have 30 calendar days from the date on a noncompliance notice to ask for reconsideration, and under the CY 2027 final rule CMS sends its decision through its data submission system, not by letter. If a disaster or other event outside your control stops reporting, you can ask for an exception within 90 days of it.

In HHVBP, the survey counts only for the larger-volume group, the agencies that run HHCAHPS. For 2026 care, which sets 2028 pay, CMS dropped three survey measures the revised questions no longer fit, kept overall rating and willingness to recommend, and cut the survey's share of the score from 30% to 20%. Your 2027 HHVBP percent was set under the old five measures.

The order of this check is our suggestion; the manual and agency guide set the rules in it.

1. Send the file by the date you agreed with your vendor. In a month with no eligible patients, the manual says to send a file or an email saying so.
2. Include each patient's skilled-visit count for the two months. The vendor has to report the number you give.
3. Get everyone into the first file. The vendor draws one sample a month; once data collection starts, patients on a later file aren't added.
4. Open the data submission report before each deadline, in time for your vendor to resubmit. The agency guide makes confirming the quarter arrived your responsibility.

Enzo is a home health EHR.

Can we run our own satisfaction survey too?

Yes. Draw the HHCAHPS sample first each month, the manual says, and don't repeat HHCAHPS questions or ask close copies such as "Would you recommend this agency to your family or friends?"

Can our vendor tell us who answered?

Only for patients who said yes to the survey's consent-to-share question. Otherwise vendors may not share who was sampled.