The Centers for Medicare & Medicaid Services’ (“CMS”) CY 2027 Home Health Prospective Payment System proposed rule (“HH PPS Proposed Rule”) confirms that community-based palliative care may be covered under the existing Medicare home health benefit-creating near-term operational questions, and longer-term strategic opportunities, for home health agencies, hospices, and other health care providers serving a frail and declining population.  

Key Takeaways

• CMS proposes to clarify that palliative care is distinct from hospice and may be covered under the home health benefit, so long as there is a skilled need for such services and the beneficiary is homebound.
• CMS declines to expand the hospice benefit or create a new palliative care benefit, likely deferring to Congress.
• This clarification will likely not expand access to palliative care in the short term but does provide an opportunity to home health providers who may not be providing such services.
• In the long-term this clarification may continue momentum to expand access to individuals who are not homebound or who are not otherwise eligible for the Medicare home health benefit; or not terminally ill with a prognosis of less than six months to live or otherwise eligible for the Medicare hospice benefit.
• Together with the GUIDE Model, this clarification continues to shine a light on home-based interdisciplinary care—for both the patient and the caregiver—and builds a growing foundation for expanding such care to people who are frail and declining.

Background

In the HH PPS Proposed Rule, CMS discusses the provision of home health palliative care services, noting that the agency is “seeking to advance its broader goal of promotion access to and utilization of palliative care services, with a particular focus on expanding opportunities for beneficiaries to receive these services under the Medicare home health benefit.”  CMS now clarifies that community-based palliative care may be covered under the existing Medicare home health benefit when a beneficiary is homebound and has a skilled need for palliative care services.

Palliative care is defined at 42 C.F.R. § 418.3 to mean “patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.”  

Specifically, palliative care may be delivered through covered home health services when the patient is homebound and has a need for skilled services under 42 C.F.R. §§ 409.32 and 409.42. CMS also clarifies that palliative care is not limited to beneficiaries who are terminally ill.

CMS notes that many core palliative care interventions already fit within existing covered home health services, such as:

• Advanced symptom assessment and management, medication management, patient and caregiver education, and ongoing observation of complex conditions.
• Medical social services addressing advance care planning and caregiver support.
• Therapy services designed to maximize function, comfort, dignity, and independence.

CMS is soliciting public comment on this proposed policy. CMS is “especially interested” in hearing more about how Medicare practitioners and post-acute care providers furnish community-based palliative case, including opportunities for improvement.

In addition, as part of the effort to promote access to and increase utilization of palliative care services, CMS included a cross-reference to a Request for Information (RFI) it previously issued to solicit public input on potential policy, operational, and payment approaches to strengthen and enhance the delivery of palliative care services outside of the hospice benefit.  The RFI comment period closed, but CMS included reference to the RFI in the HH PPS Proposed Rule and invites stakeholders to address palliative care topics in their HH PPS Proposed Rule comments as well.

Lastly, CMS plans to provide additional palliative care examples of skilled care to the Medicare Benefit Policy Manual following publication of the final HH PPS rule to support its goal of encouraging community-based palliative care services under the Medicare home health benefit.

What Should Medicare Practitioners Do Now?

• Home health agencies and their partners should consider partnering with a hospice to deliver palliative care services outside of home health, and should build the clinical documentation and utilization review expertise necessary to support skilled-need determinations for palliative care furnished inside of home health. Foley Hoag attorneys are available to advise on the legal, compliance, and reimbursement considerations inherent in any such arrangement.
• Providers should also confirm that intake, assessment, and billing workflows capture homebound status and the specific skilled need supporting each palliative care visit, since these clarifications do not change the underlying coverage criteria or documentation requirements.
• CMS plans on adding additional palliative care examples of skilled care to the benefit policy manual to support CMS’ goal of encouraging community-based palliative care services, particularly under the Medicare home health benefit. CMS solicits comments on any concerns or suggestions regarding reaching this goal.
• Comments are due no later than 5:00 PM EDT on August 31, 2026, and may be submitted at https://www.regulations.gov/commenton/CMS-2026-2311-0002. Foley Hoag attorneys are available to assist you with your submission.