TL;DR
CMS’ proposed 2027 home health payment rule would clarify that skilled services covered under the Medicare Home Health Benefit can be palliative in nature. Eligibility requirements would remain unchanged, and industry representatives say existing bundled payments may limit agencies’ ability to provide broad, interdisciplinary palliative care.
The Centers for Medicare & Medicaid Services has proposed clarifying that skilled services covered by the Medicare Home Health Benefit may be palliative in nature. The proposal, included in CMS’ 2027 home health payment rule, would not change who qualifies for the benefit. Providers say current payment limits could make extensive palliative services difficult to deliver.
CMS’ proposal addresses how existing home health coverage requirements apply when care is intended to relieve symptoms or support quality of life, rather than being understood solely through an expectation that a patient’s condition will improve. The proposal does not create a separate home health benefit or remove the existing coverage criteria, according to the source report.
To qualify, a patient must be homebound, need part-time or intermittent skilled services, have an in-person appointment with a doctor or other health professional confirming the need for home health care, and receive services through a Medicare-approved agency. CMS has said it plans to issue sub-regulatory guidance with examples of skilled palliative care, which could help agencies and reviewers apply the clarification to individual cases.
Industry representatives have welcomed the proposed recognition. Beau Sorensen, chief operating officer of First Choice Home Health & Hospice, previously called palliative care’s inclusion “one of the standout positives” in the rule, according to Home Health Care News. The proposal remains part of a proposed rule; it is not described in the source material as a finalized policy.
How Coverage Could Change Care
Clearer recognition of palliative services could affect how agencies serve patients whose skilled care needs meet existing eligibility requirements. Katie Wehri, vice president of regulatory affairs, quality and compliance at the Alliance for Care at Home, told Palliative Care News that examples in a CMS manual could help providers explain to reviewers why a case meets coverage requirements.
The clarification could also encourage agencies to coordinate with a wider range of clinicians. Katy Barnett, director of home care, hospice operations and policy at LeadingAge, said agencies may build more relationships with oncologists managing care at home, as well as physical and occupational therapists assisting patients with mobility after a new diagnosis or chronic condition.
Coverage clarification does not establish a funding stream for every element of palliative care. Barnett said agencies receive a bundled payment based on a patient’s condition and acuity. After nursing visits and other immediate needs are paid for, agencies may have limited resources for social, spiritual or aide visits. Wehri said comprehensive interdisciplinary palliative care can be cost-prohibitive under the current structure.
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Existing Eligibility Still Applies
The proposed clarification is linked by Wehri to the 2013 Jimmo Settlement, which clarified that Medicare coverage should be based on the services a patient needs, not solely on whether the patient is expected to improve. She described CMS’ proposal as reaffirming that palliative skilled services can fit within existing home health requirements, including homebound status and the need for skilled care.
That does not make home health and hospice interchangeable. The source report says the home health benefit’s payment structure may make it harder for agencies to provide the kind of broad, interdisciplinary services associated with hospice. Wehri also said agencies advertising palliative care may deliver some of it through a related Medicare Part B physician-visit service, rather than through the home health payment bundle alone.
““In addition to all of the coverage requirements that we have outlined in the existing home health manual, we want to clarify that these skilled services that are covered can be palliative in nature.””
— Katie Wehri, Alliance for Care at Home
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Guidance and Payment Questions
The proposal’s final form and implementation details remain unresolved in the source material. CMS has said it plans to issue guidance with examples, but the timing and content of that guidance are not specified. It is also unclear how reviewers will apply the clarification in individual cases or how many agencies will change their practices.
The proposal does not appear to change the bundled payment structure described by provider representatives. It therefore remains uncertain whether agencies will be able to expand interdisciplinary services without additional resources, or whether some will rely on affiliated providers and other payment arrangements. The source report does not provide estimates of expected patient uptake or costs.
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Final Rule and CMS Guidance
CMS is expected to continue the rulemaking process for its calendar year 2027 home health payment rule. The source material does not specify a final-rule date or the length of the comment period. If the clarification is adopted, CMS’ planned sub-regulatory guidance will provide agencies with examples of qualifying skilled palliative services.
The final policy will determine whether the clarification changes coverage practice while leaving payment limits intact. That distinction will affect whether the proposal primarily provides documentation guidance or results in changes to access to palliative services at home.
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Key Questions
What is CMS proposing?
CMS proposes clarifying that skilled services covered under the Medicare Home Health Benefit can be palliative in nature. The proposal is part of the calendar year 2027 home health payment rule.
Would the proposal change who qualifies for home health?
No change to eligibility is described. Patients would still need to be homebound, require part-time or intermittent skilled services, receive confirmation of need at an in-person appointment, and use a Medicare-approved home health agency.
Does the proposal create a separate palliative care benefit?
The source material describes a clarification within the existing home health benefit, not a separate benefit. Existing coverage requirements would continue to apply.
Why might agencies still struggle to provide broad palliative care?
Provider representatives say home health agencies receive bundled payments and may have limited funds for social, spiritual and aide services after paying for nursing and other immediate needs. The proposal does not, as described, change that payment structure.
What happens next?
CMS will continue the rulemaking process and has said it plans to issue guidance with examples of skilled palliative care. The final policy and guidance details are not yet specified in the source material.
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