CMS Clarifies Palliative Care Delivery Under Home Health Benefits
While the field of palliative care has been encouraged by the Center for Medicare and Medicaid Services (CMS) recent discussions in the CY2027 proposed rules for both hospice and now home health, there are no proposed changes in payment or quality measures to support home-based palliative care. The home health proposed rule clarifies that "the restoration potential of a patient is not the deciding factor in determining whether skilled services are needed" and that skilled services can address symptom management, medication management, advanced care planning, and function to improve quality of life. Specifically, the proposed rule notes that the current home health payment system (Patient-Driven Grouping Model, or PDGM) already has a clinical group—Medication, Management, Teaching, and Assessment (MMTA)—which aligns with palliative care services, and that additional sub-regulatory guidance will soon be issued to illustrate this.
Despite no modifications to the existing payment system, there is hope that this clarifying rule will reduce barriers to both admission and primary palliative care services in home health agencies. The proposed rule solicits public comments, due by August 31. CAPC intends to recommend a requirement for formal collaboration with a palliative care-trained medical clinician, and that agencies delivering primary palliative care demonstrate appropriate training for their staff.