What will HHVBP do to your Medicare payment in 2027?
The short answer
In 2027, HHVBP will raise or cut your payment on every traditional Medicare home health claim by one fixed percent, up to 5% either way, set by how your 2025 quality scores compared with agencies your size. On $5 million of Medicare revenue, each 1% is $50,000 a year.
Your 2027 percent was set by the care your agency gave in 2025, so there's little left to change. What's left is checking it, and getting ready for the bigger scorecard that grades your 2026 care.
Home Health Value-Based Purchasing (HHVBP) is Medicare's pay-for-quality program for home health, and it has covered every Medicare-certified agency since 2022, with no sign-up and no opting out. CMS scores one calendar year and applies the result to your claims two years later: 2025 sets 2027, and 2026 sets 2028.
What 2027 could mean in dollars
You won't get a separate HHVBP check. Medicare adjusts the final payment on each traditional Medicare (fee-for-service) home health claim with a through date from January 1 to December 31, 2027. CMS's own example: a $3,500 final claim with a 1.018% adjustment gets $35.63 more.
On $5 million of Medicare fee-for-service home health revenue, each 1% is $50,000 a year, about $4,200 a month. At the 5% limit it's $250,000 a year, added or taken. Multiply your own Medicare revenue by your own percent for your number.
HHVBP doesn't add money to home health as a whole: CMS keeps the model budget neutral and, for 2027, expects "no aggregate increases or decreases" in payments to agencies, so the gains and cuts cancel out.
What you were scored on, and what changes for 2026
Six of your 2026 measures come from OASIS, up from three in 2025. Those are answers your clinicians typed at the start and end of care. If your teams have been loose on function items at start of care and discharge, that habit now touches more of your payment than it used to.
| 2025 care (2027 pay) | 2026 care (2028 pay) | |
|---|---|---|
| From OASIS | Improvement in shortness of breath (dyspnea) and in managing oral medications; discharge function score | The same three, plus improvement in bathing, upper body dressing and lower body dressing |
| From Medicare claims | Potentially preventable hospitalization during the stay; discharge to community | The same two, plus Medicare spending per beneficiary |
| Patient survey | Five measures, from care of patients to willingness to recommend | Two: overall rating, willingness to recommend |
| Weights, larger agencies | OASIS 35%, claims 35%, survey 30% | 40%, 40%, 20% |
| Weights, smaller agencies | OASIS 50%, claims 50% | No change |
Three of those OASIS measures (bathing, shortness of breath and oral medications) also feed your quality of patient care star rating.
Fine print
CMS's FAQ says discharge to community and Medicare spending per beneficiary count home health stays that ended over 24 months, not 12. So part of the score behind your 2027 percent reaches back into 2024.
How your score becomes a percent
CMS splits agencies into two national groups. Larger agencies run the HHCAHPS patient survey. Smaller ones are exempt, which means fewer than 60 survey-eligible patients in the year before the year being scored. CMS updates the split every July, and your points and your percent are both set inside your group.
On each measure, CMS scores you two ways and keeps the higher one. First against other agencies: do better than the middle agency did in CMS's baseline year and you start earning points, up to the full 10 if you reach the average of the best 10%. Then against yourself: do better than your own baseline year and you can earn up to just under 9 points, even if you're still behind most agencies.
You need at least five measures with enough data behind them to get a score: 20 episodes a year for each OASIS or claims measure, and 40 completed surveys for each survey measure. Your weighted points add up to a Total Performance Score from 0 to 100.
That score doesn't map to a fixed percent. CMS lines up every scored agency in your group and turns each score into a percent along one straight line, so your percent depends on how everyone else did. CMS's FAQ says a score above the group's average would typically get a positive adjustment, and one below it a negative one. No one goes past 5% either way. Your percent can even shift between report versions if another agency's appeal corrects data in your group.
Your score, its percentile and your percent are public on a CMS website, for referral sources and anyone else to see.
Where the report with your percent stands
Look for it in iQIES now, and if it isn't there, write to the help desk (steps below). The report is the final CY 2026 Annual Performance Report, and as of November 6, 2026 CMS's own pages disagree on whether it's out. CMS's model page says "Final CY 2026 Annual Performance Reports (APRs) are Available in iQIES," with no date on the notice. Its June 2026 newsletter had scheduled the final report for November 25, 2026, "or as soon as technically feasible." Its June 2026 FAQ says the final report comes in December.
The windows to dispute this report opened with the preview version in August and the preliminary version in October. CMS's FAQ offers a recalculation only on the preview annual report and the preliminary quarterly reports, and names no window for the final one.
The next report that counts is the October 2026 interim report, the first to score you on the 2026 measures. The June newsletter scheduled its preliminary version for November 12.
What to do before January 1
- Look for your final annual report in iQIES. Sign in to iQIES and open the HHA Provider Preview Reports folder for your CMS Certification Number (CCN). CMS emails its HHVBP and iQIES mailing lists when reports go up. Once it's there, check your group, each measure result, your Total Performance Score and your percent against your own records.
- If the report is missing or something looks wrong, write to the HHVBP help desk. The address is HHVBPquestions@cms.hhs.gov; CMS asks you to include your name, your agency's name and its CCN.
- Read the preliminary October interim report the day it posts. Your 15 calendar days to ask for a recalculation start then.
- Look at the 2026 measures now. Bathing and dressing are new. Pull a handful of recent discharges and see whether start of care and discharge answers on those items tell a believable story.
Enzo is a home health EHR. Two of its tools work on OASIS documentation, the source of six of your 2026 measures, as your clinicians write it and your reviewers check it. Enzo Scribe turns the visit into complete, OASIS-ready notes and flags gaps against OASIS requirements before anything goes to review. Enzo QA reviews every chart before submission, including OASIS responses and Plan of Care alignment, and explains what needs attention and why.
Questions agencies are asking
Did the 2027 payment rule change HHVBP?
No. CMS's November 4 final rule made no HHVBP changes. Your HHVBP percent still moves your own claims up or down on top of whatever the rule does to rates.
Does a new agency get an adjustment?
Not right away. A newly certified agency's first full calendar year is its baseline year, and its first performance year is the one after. In CMS's FAQ example, an agency certified in 2024 is first paid on its scores in 2028.
Does HHVBP touch my Medicare Advantage revenue?
No. It adjusts traditional Medicare fee-for-service home health claims only.