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CMS’ proposed CY2027 home health payment rule would add palliative care as a billable service under the Medicare Home Health Benefit. Industry groups say the clarification, aligned with the 2013 Jimmo Settlement, addresses coverage ambiguity, but warn that current bundled payment structures limit how robust palliative services can be.
The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed adding palliative care as a billable service under the Medicare Home Health Benefit in its proposed CY2027 home health payment rule. Industry groups say the change would clarify coverage for seriously ill patients receiving care at home, and some have questioned whether agencies can deliver comprehensive palliative services under existing payment structures.
According to reporting by Home Health Care News, the proposed rule would clarify that skilled services covered under the home health benefit can be palliative in nature. Katie Wehri, vice president of regulatory affairs, quality and compliance at the Alliance for Care at Home, said the proposal revisits existing coverage requirements rather than creating new ones. “It’s really going back to review the home health requirements for homebound status, skilled services and the coverage requirements and saying, ‘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,'” Wehri told Palliative Care News.
The proposal aligns with the 2013 Jimmo Settlement, which clarified that the Medicare home health benefit allows providers to bill based on the services a patient needs, not solely on whether a patient’s condition is expected to improve. The rule does not change eligibility requirements: patients must still be homebound and require part-time or intermittent skilled services, have an in-person appointment confirming the need for home health care, and receive services from a Medicare-approved agency.
CMS indicated in a fact sheet that it plans to issue sub-regulatory guidance that includes examples of skilled palliative care. Wehri said those examples may give agencies confidence to serve eligible patients whose needs are not clearly identified, providing documentation support to show reviewers that such cases meet coverage requirements.
Impact on Agencies and Seriously Ill Patients
Several home health providers have expressed support for the proposal. Beau Sorensen, chief operating officer of First Choice Home Health & Hospice, called the inclusion of palliative care “one of the standout positives in the rule.” Industry analysts said the clarification could also lead agencies to form new relationships across the care continuum. Katy Barnett, director of home care, hospice operations and policy at LeadingAge, said agencies might partner more with oncologists managing patients’ care at home, and that palliative support could expand physical therapy and occupational therapy referrals for patients adjusting to new chronic conditions or diagnoses.
According to industry representatives, the change could reduce ambiguity around coverage for comfort-focused care at home. This population has historically faced scrutiny over whether improvement is required for coverage, despite the Jimmo Settlement’s clarification.
Payment Limits Under the Current Model
Industry groups cite how home health is paid as a constraint on palliative services. Agencies receive a bundled payment per patient based on condition and acuity level. After paying for nursing visits, agencies often have limited funds remaining to cover social work, spiritual care or aide visits — components of interdisciplinary palliative care as delivered through the hospice benefit.
Barnett said clinical priorities tend to consume the bundle first. “If the priority is making sure that they’re taking their meds so they don’t get nausea, if it’s making sure that you’re in there fixing significant wounds that they received from being in the hospital for so long, those things take priority, because that’s the comfort measure for that individual,” she said. Wehri said offering a comprehensive, interdisciplinary palliative care plan is cost-prohibitive for most agencies under current payment structures, noting that agencies advertising palliative services today often deliver them through a sister Medicare Part B physician visiting service rather than the home health benefit itself.
“We want to clarify that these skilled services that are covered can be palliative in nature.”
— Katie Wehri, Alliance for Care at Home
Open Questions on Guidance and Final Rule
Several elements remain unresolved. The rule is still proposed, not final, and its contents could change based on public comments. The content of CMS’ planned sub-regulatory guidance — including what specific examples of skilled palliative care it will include — has not been published. It is also unclear whether CMS will address the payment limitations that Barnett and Wehri say make interdisciplinary palliative care cost-prohibitive under the bundled payment model. Whether agencies will expand palliative offerings, and how quickly, remains to be seen.
Comment Period and Final Rule Timeline
The proposal moves through the standard rulemaking process: a public comment period followed by publication of the final CY2027 home health payment rule, typically issued in the fall ahead of the calendar year it covers. Stakeholders including the Alliance for Care at Home and LeadingAge are expected to submit comments, particularly on payment adequacy for palliative services. After finalization, agencies will await CMS’ promised sub-regulatory guidance for concrete examples of covered skilled palliative care.
Key Questions
Does the proposed rule change who qualifies for home health care?
No. Eligibility requirements remain the same: patients must be homebound and need part-time or intermittent skilled services, have an in-person appointment confirming the need for care, and receive services from a Medicare-approved home health agency.
What exactly would the proposed rule do?
It would clarify that skilled services already covered under the Medicare Home Health Benefit can be palliative in nature, making palliative care a billable service and giving agencies clearer documentation support for these cases.
How does this relate to the 2013 Jimmo Settlement?
The proposal aligns with the settlement, which clarified that Medicare covers home health services based on a patient’s needs, not on whether their condition is expected to improve.
Will home health palliative care match hospice-level palliative services?
Not necessarily. Industry experts say the bundled home health payment often leaves too little money after nursing visits to fund social, spiritual and aide services, making fully interdisciplinary palliative care cost-prohibitive for most agencies under current payment structures.
What is CMS doing to help agencies implement this?
According to a CMS fact sheet, the agency plans to issue sub-regulatory guidance with examples of skilled palliative care, which industry advocates say will help agencies confidently serve eligible patients.
Source: rss
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