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CMS’s proposed 2027 Medicare home health rule would clarify that covered skilled services may be palliative in nature. The proposal would not change eligibility, and providers say current bundled payments may limit the interdisciplinary care agencies can afford to offer.
The Centers for Medicare & Medicaid Services has proposed clarifying that skilled services covered under the Medicare Home Health Benefit may be palliative in nature. The proposal is part of CMS’s 2027 home health payment rule and would not change the benefit’s existing eligibility requirements.
CMS’s proposal would address how home health requirements for homebound status, skilled services and coverage apply when a patient needs palliative care. Katie Wehri, vice president of regulatory affairs, quality and compliance at the Alliance for Care at Home, told Palliative Care News that the proposal clarifies that covered skilled services can be palliative, alongside the requirements already set out in the home health manual.
Patients would still need to be homebound and require part-time or intermittent skilled services. They would also need an in-person appointment with a doctor or other health care professional who confirms that home health care is needed, and services would have to come from a Medicare-approved home health agency. CMS said it plans to issue sub-regulatory guidance with examples of skilled palliative care.
Providers have commented on the proposed clarification. Beau Sorensen, chief operating officer of First Choice Home Health & Hospice, described the inclusion of palliative care as a positive aspect of the rule in comments previously reported by Home Health Care News. Wehri said examples in guidance could help agencies assess whether a case meets coverage requirements when a patient’s needs are not clearly identified.
How Coverage Could Reach More Patients
The clarification could give agencies a clearer basis for accepting eligible patients whose skilled care focuses on comfort and symptom management. Wehri said some patients’ needs may not be obvious under existing guidance, and examples in the manual could help agencies and reviewers assess whether a case meets the requirements. That could make it easier for patients to receive skilled palliative support at home through the benefit when they qualify.
The proposal may also prompt agencies to build ties with other clinicians. Katy Barnett, director of home care, hospice operations and policy at LeadingAge, said agencies might work more with oncologists managing care at home, or coordinate physical and occupational therapy for patients with a new chronic condition or diagnosis. These are potential opportunities described by Barnett, not changes guaranteed by the rule.
Providers say clearer coverage language would not, by itself, pay for the full range of palliative services. Home health agencies receive a bundled payment based on a patient’s condition and acuity. Barnett said nursing needs such as medication management or wound care can take priority, leaving limited funds for social, spiritual or aide visits. Wehri said a comprehensive interdisciplinary plan is cost-prohibitive for most agencies under the current structure.
Existing Rules Still Set Eligibility
The proposed language is tied to the existing home health benefit, rather than a new eligibility pathway. Wehri said it aligns with the 2013 Jimmo Settlement, which clarified that Medicare home health coverage can be based on the services a patient needs, rather than solely on whether the patient is expected to improve. The proposal would clarify that covered skilled services may be palliative in nature.
Palliative care and hospice care are distinct in the source report’s account of the proposal. Providers say home health agencies may face financial barriers to delivering palliative care with the interdisciplinary breadth associated with hospice. Wehri said agencies that advertise palliative care may use a sister company, often a Medicare Part B physician visiting service, to provide some of that care. The proposed coverage clarification does not itself alter the home health payment bundle described by providers.
““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
Payment Limits Remain Unresolved
The proposal’s practical effect will depend in part on CMS’s forthcoming guidance, including which examples of skilled palliative care it provides and how agencies and reviewers apply them. The source report does not specify when the guidance will be issued or describe a final rule.
It is also unclear whether the proposal would lead to more agencies accepting patients whose needs are palliative, or how much care agencies would be able to provide. The bundled payment structure remains a constraint identified by providers; the proposed clarification does not describe a change to that payment approach. CMS has not, in the supplied material, set out how agencies could fund services beyond the skilled care covered under existing requirements.
CMS Guidance Will Add Examples
CMS plans to provide sub-regulatory guidance with examples of skilled palliative care, according to its fact sheet. Those examples are expected to help agencies understand how palliative services fit within current coverage rules. The source material does not provide a release date or detail the next steps in the rulemaking process.
Agencies, clinicians and patients will be watching how the final policy and guidance address coverage in practice. Even if the clarification takes effect as proposed, providers say the scope of interdisciplinary services agencies can offer will remain connected to the resources available within the existing payment structure.
Key Questions
What would CMS’s proposal change?
It would clarify that skilled services covered by the Medicare Home Health Benefit may be palliative in nature. It would not create a separate eligibility pathway.
Would patients have different eligibility requirements?
No. The proposal would leave existing requirements in place, including being homebound, needing part-time or intermittent skilled services, having an in-person appointment confirming the need for home health care, and receiving care from a Medicare-approved agency.
Will the proposal pay for a full interdisciplinary palliative care team?
The supplied material does not describe a new payment for comprehensive palliative care. Providers say the current bundled payment can leave limited funds for social, spiritual or aide visits after nursing needs are covered.
What happens next?
CMS plans to issue sub-regulatory guidance with examples of skilled palliative care. The source material does not state when that guidance will appear or give a date for the rule’s next milestone.
Source: rss
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