Palliative Care Addition To Home Health
CY 2027 HH PPS
What CMS is not doing
It is not creating a new palliative care benefit, a new payment category, or a separate palliative rate. Nothing here adds a line to the fee schedule.
What CMS is doing
Clarifying that palliative care already fits inside the existing Medicare home health benefit. Skilled need is judged on the patient in front of you, not on whether the illness is acute, chronic, or terminal.
What still must be true
The patient is homebound, needs skilled care, and the services are ordered by an allowed practitioner and documented to that standard. The clarification widens recognition, not eligibility.
- Restoration potential is not the deciding factor. A patient may need skilled services to prevent deterioration or preserve current capabilities, even where full recovery is not possible.
- The skilled judgment belongs to the practitioner. An allowed practitioner familiar with the patient determines whether a service is reasonable and necessary, against accepted standards of practice.
- The work is already in the benefit. Skilled nursing can address advanced symptom management, including pain, nausea and vomiting, anxiety, and respiratory distress. Medical social services can address advance care planning.
Proposed
This is a proposed rule, not a final rule. CMS-1844-P, published in the Federal Register at 91 FR 41216 on July 6, 2026, with the comment period open. Payment figures on this page are the proposed CY 2027 numbers and can change in the final rule.
How The Opportunity Model Is Built
planning assumptions
Each state is modeled on its own home health spend per user, then summed. The two branches are different questions: the capture pool is fee for service revenue an agency could bill today, while the value based figure is total cost of care savings available to whoever holds the risk.
Where The Volume And The Economics Sit
10 CMS regions
Proposed CY 2027 Payment Impact By Region
from the rule
CMS estimates aggregate home health payments rise by $420 million, or 2.4 percent, in CY 2027. The dashed line is that national figure. Regional spread comes from the wage index and case mix effects in the rule impact table. Among the nine census divisions, Mid-Atlantic carries the strongest tailwind at 3.6 percent across only 360 agencies, while Pacific pairs 3.0 percent with 2,880 agencies. The Outlying group also shows 3.6 percent, but on just 1,545 home health users.
All States And Territories
53 jurisdictions
Original Medicare only. Medicare Advantage lives are outside this file and outside these totals.
Who The Palliative Ready Patient Is
condition mix
Segment shares are planning assumptions applied to the 839,887 candidate pool, not counts observed in the CMS file.
Method And Sources
reproducible