How are home health star ratings calculated in 2027?

Care Compare, Medicare's public comparison site, has shown the quality of patient care star since July 2015 and the patient survey star since January 2016. Both update every quarter.

Both grade you against other agencies. CMS's preview report says most agencies land "in the middle" at 3 stars; above 3 means better than average on the measured care, below 3 means worse.

Six come from your OASIS: timely initiation of care, and improvement in ambulation, bed transferring, bathing, shortness of breath and management of oral medications. For the five improvement measures, CMS compares what your clinician recorded at start or resumption of care with what they recorded at discharge; episodes that end in an inpatient transfer or death don't count toward those five. The seventh, potentially preventable hospitalization during the stay, comes from Medicare claims, so a potentially preventable hospital or observation stay counts against you whether or not anyone at your agency wrote it down.

1. Rank. For each measure, CMS lines up every agency's score and cuts the line into ten roughly equal groups.
2. Assign. Your group on each measure becomes a starting rating from 0.5 to 5.0, in half steps.
3. Pull toward the middle. If your data can't show you're clearly better or worse than the national middle, CMS moves that rating half a step toward 2.5 or 3.0.
4. Average. CMS averages your ratings across up to seven measures and rounds to the nearest half.
5. Convert. A last table maps that onto 1 to 5 stars: an average of 0.5 becomes 1 star, 3.0 becomes 3.5 stars, and 4.5 or 5.0 both become 5 stars.

CMS's sample preview report for the January 2027 refresh runs a made-up agency through those steps. It averages 3.2, rounds to 3.0 and posts at 3.5 stars. In our read, step 3 hits small agencies hardest: with few episodes behind a measure, it's harder to prove you're different from the middle, good or bad.

The ranges can be narrow. In that sample, a 3.0 on timely initiation of care covers scores from 97.9% to 98.7%, and only 100.0% earns a 5.0. Your own preview report carries the real ranges for your refresh, and CMS updates them every quarter.

By our arithmetic on CMS's method, one measure slipping one group moves a seven-measure average by about 0.07. That's enough to tip you to the lower half star when your average sits just above a rounding line.

The January 2027 quality star uses OASIS episodes that ended April 1, 2025 through March 31, 2026, and hospitalization claims from calendar 2025. CMS keeps a nine-month lag on OASIS data to leave room for corrections, and updates the claims measure once a year.

So a change you make this month won't reach your star for most of a year. To see where your state stood in the October 2026 refresh, our state-by-state star ratings page ranks every state on the quality star.

Expect your survey star to rest on a changing survey through 2027. Today CMS turns each survey answer into a 0 to 100 score, adjusts for patient mix, averages four quarters and sorts agencies into five groups. Your summary star is the average of four measure stars: care of patients, communication between providers and patients, specific care issues, and the overall rating of care (question 20). Willingness to recommend is reported but gets no star, because CMS found it tracks the overall rating too closely.

A shorter survey started with the April 2026 sample month, under the CY 2026 payment rule. CMS retires specific care issues and treats the revised care of patients and communication measures as new, so they won't be reported until four quarters of new data exist, which CMS expects in the October 2027 refresh. Until then, the overall rating and willingness to recommend keep being reported, blending old and new survey quarters.

The October 2026 refresh still covers April 2025 to March 2026, all from the old survey, and HHCAHPS posted star cut points for all four measures. Neither the rule nor CMS's star ratings page says how the summary star is built in the refreshes between now and October 2027.

CMS's star ratings pages tie no payment to the star. The cost reaches you through who picks you and through HHVBP.

Families and referral sources can see your stars. Schwartz and colleagues (Health Services Research, 2022) looked at 186,498 admissions of new Medicare fee-for-service home health patients before and after stars appeared. The stars were associated with a 0.88 percentage point rise in the chance of choosing a high-quality agency, and 0.81 points for a highly ranked patient experience agency, weaker than in settings that show a single star.

We don't know of a study that prices a half star for one agency.

Home Health Value-Based Purchasing moves your traditional Medicare home health payment up or down by as much as 5%, two years after the year it scores. Several star measures sit inside it:

In our read, a slip on shortness of breath or oral medications costs you on your star and your Medicare adjustment from the same charts. You can work out the dollars for your agency with what HHVBP will do to your Medicare payment in 2027.

Your Review and Correct reports in iQIES show your OASIS measures for the past four full quarters and whether each quarter's correction period is open or closed. Only corrections made by each deadline count toward Care Compare and your star.

After that, the preview report is your last look. It lands about 3.5 months before posting, and each refresh has its own review window; for January 2027, requests were due October 30, 2026. A review fixes only a calculation error. CMS says inaccurate OASIS recording isn't a valid reason, since the Conditions of Participation already require accurate OASIS. If CMS confirms an error, the remedy is a one-time suppression of the star and affected measures for one quarter.

The timing in this plan is our suggestion; CMS sets only the deadlines.

1. Count the seven. One rate per measure from last month's episodes: discharges for the five improvement measures, and discharges, transfers and deaths for timely initiation.
2. Compare against your own agency a year ago. The national ranges move every quarter.
3. Read charts when a measure falls two months running. Compare start of care with discharge.
4. Open Review and Correct before each quarter's deadline. Fix submission errors while the period is open.
5. Read your vendor's HHCAHPS reports, overall rating first.

Enzo is a home health EHR. Enzo Scribe turns the visit into complete, OASIS-ready notes and flags gaps against OASIS requirements before anything goes to review; the clinician reviews and signs off. Enzo QA reviews every chart before submission, including OASIS responses, and explains what needs attention and why; your team makes the call.

Why don't we have a star at all?

For the quality star, you need 20 completed episodes on at least five of the seven measures, and CMS's preview report says agencies certified or recertified less than six months ago show "data not available." For the survey star, you need 40 completed surveys over four quarters; with fewer, Care Compare can still show your survey scores, just without a star.

Why did our star change when our care didn't?

Because the star is a ranking. Every other agency's scores move too, the ranges are recalculated each quarter, and each quarterly refresh moves the OASIS window forward by a quarter.

Does all-payer OASIS change our star?

Not yet. You've had to submit OASIS for every patient since July 1, 2025, but CMS says its OASIS measures are still calculated only for Medicare fee-for-service, Medicare Advantage, Medicaid and Medicaid managed care patients.