Routine Home Care Rate Tiers

Routine Home Care rate tiers are the two-level RHC per-diem structure Medicare uses: a higher daily rate for days 1–60 of an election and a lower rate for day 61 and beyond. For FY2026 the rates are $230.83 per day for days 1–60 and $181.94 per day for day 61 and after (CMS FY2026 Hospice Wage Index final rule fact sheet)^[1].

CMS replaced the single flat RHC rate with these two tiers in the FY2016 final rule to better match payment to the U-shaped cost curve of hospice care, where resource use is highest at the start and end of an episode (CMS FY2016 final rule)^[2]. The day count is cumulative across the patient's hospice history for the same terminal illness, and it does not reset for gaps of 60 days or less between elections; a new count begins only after a break in hospice care of more than 60 days. Each RHC rate is split into a labor portion (66.0% for RHC in FY2026) and a non-labor portion, with the labor portion adjusted by the hospice wage index for the patient's location (CMS FY2026 final rule fact sheet)^[1]. The SIA is layered on top of the RHC rate for qualifying visits in the last seven days of life. The FY2027 final rule (CMS-1851-F, July 30, 2026) increases all hospice rates, including both RHC tiers, by 2.3% (CMS FY2027 final rule fact sheet)^[3].

Admission timing and episode composition drive a hospice's realized RHC yield because the day-60 rate change applies at the patient level, not the program level. A patient who crosses day 60 drops by roughly $48.89 per day at FY2026 rates, depressing blended revenue per patient day for programs with a heavy tail of very-long-stay patients and separately increasing aggregate cap exposure. For same-diagnosis re-elections that do not reset the day counter, the lower day 61+ tier applies from the first day of the new election, making accurate cumulative day-count tracking a billing requirement with direct financial consequence: an incorrect count results in either underpayment or an overpayment subject to recoupment.