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CMS’ proposed 2027 Medicare home health payment rule would clarify that covered skilled home health services may be palliative in nature. The proposal would not change eligibility, and providers say current bundled payments may still limit access to broader, team-based palliative care.
The Centers for Medicare & Medicaid Services has proposed clarifying that skilled services covered under the Medicare Home Health Benefit may be palliative in nature, a change that could give home health agencies more confidence serving patients with serious or chronic conditions. The proposal, part of CMS’ calendar year 2027 home health payment rule, would not alter the benefit’s eligibility requirements or create a separate palliative care benefit.
The proposal addresses how agencies may provide and bill for covered home health services when the care is intended to relieve symptoms or support a patient’s needs, rather than to improve the underlying condition. Katie Wehri, vice president of regulatory affairs, quality and compliance at the Alliance for Care at Home, told Palliative Care News that CMS is reviewing existing requirements for homebound status, skilled services and coverage to clarify that qualifying skilled care can be palliative.
CMS said in a fact sheet that it plans to issue sub-regulatory guidance with examples of skilled palliative care. Wehri said those examples could help agencies and reviewers identify appropriate cases, particularly when a patient’s needs are not clearly recognized under existing practice. The proposal itself does not change the standards a patient must meet to receive home health care.
To qualify, a patient generally 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. The proposal clarifies the nature of services that may be covered within those requirements; it does not remove them.
Potential Reach, Existing Payment Limits
The clarification could encourage agencies to accept patients whose care needs include symptom relief and other palliative support, and could prompt more coordination with clinicians outside traditional home health teams. Katy Barnett, director of home care, hospice operations and policy at LeadingAge, told Palliative Care News that agencies might build relationships with oncologists managing patients at home or incorporate physical and occupational therapy to help people function with a new diagnosis or chronic condition.
But the proposal does not resolve a central obstacle: how home health care is paid for. Agencies receive a bundled payment based on a patient’s condition and acuity. Barnett said nursing needs can consume much of that payment, leaving limited funds for social work, spiritual care or aide visits. That may make it difficult to provide the broad, interdisciplinary support often associated with palliative care.
Wehri said a comprehensive palliative program can be cost-prohibitive under current payment arrangements. She said some agencies that advertise palliative care may rely on a related Medicare Part B physician-visit service to deliver it. The proposed clarification could support recognition of palliative skilled services, but it does not itself establish new payment rates or guarantee funding for a full team-based model.
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How Home Health Coverage Applies
The proposed clarification follows the 2013 Jimmo Settlement, which clarified that Medicare coverage is not limited to care expected to improve a patient’s condition. As Wehri described it, the settlement supports coverage based on the services a patient needs, provided existing requirements are met. CMS’ proposed language would make clearer that those skilled services can have a palliative purpose.
Home health and hospice are distinct Medicare benefits. This proposal concerns the Home Health Benefit; it does not replace hospice eligibility or make home health palliative care equivalent to the interdisciplinary services available through hospice. Home health providers have welcomed the proposed clarification. Beau Sorensen, chief operating officer of First Choice Home Health & Hospice, described palliative care’s inclusion as a bona fide reason for home health services as a positive feature of the rule, according to Home Health Care News.
““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, vice president of regulatory affairs, quality and compliance at the Alliance for Care at Home
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Coverage Clarification, Not New Funding
The proposal remains subject to CMS’ rulemaking process. The precise wording of any final rule, the timing and content of the promised examples, and how reviewers will apply the clarification are not yet clear. CMS has said it plans to issue guidance, but the source material does not provide a publication date.
It is also uncertain how many agencies will expand palliative services in response. The proposal does not change eligibility or payment rates, and providers say bundled payments can constrain visits beyond core skilled nursing needs. The extent to which the policy will translate into more social, spiritual or aide support is therefore unknown.
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Final Rule and CMS Guidance
CMS will continue the rulemaking process for the 2027 home health payment rule before issuing a final version. The agency has also indicated it plans to publish sub-regulatory guidance with examples of skilled palliative care. Agencies, providers and patients will need those final details to understand how the clarification will be applied in practice; no implementation date or final policy terms are established in the source material.
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Key Questions
What would CMS change under the proposal?
CMS would clarify that skilled services covered by the Medicare Home Health Benefit may be palliative in nature. The proposal does not create a separate palliative care benefit.
Would patients face different eligibility requirements?
No. The proposal would not change the existing requirements, including being homebound, needing part-time or intermittent skilled services, having an in-person professional assessment, and receiving care from a Medicare-approved agency.
Does the proposal guarantee more comprehensive palliative care?
No. Providers say current bundled payments can leave limited funds for social, spiritual and aide services after nursing needs are paid. The proposal does not establish new payment rates or guarantee interdisciplinary care.
What guidance has CMS said it will provide?
CMS said it plans to issue sub-regulatory guidance with examples of skilled palliative care. The timing and final content of that guidance have not been specified in the source material.
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