Ask most agencies whether they can take a palliative patient and the answer comes back fast: that's hospice. It isn't ours.
In the CY 2027 proposed rule, CMS says otherwise — plainly, and in a section most people will skip because it proposes no payment change.
What CMS Actually Says
Section II.F of the CY 2027 proposed rule discusses the provision of palliative care services under the Medicare home health benefit. CMS states that it is "seeking to advance its broader goal of promoting 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."
Then it gets specific about coverage. Quoting the regulation at 42 CFR 409.32(a), CMS notes that to be considered a skilled service, the service "must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel."
And then the sentence that matters:
Under the home health benefit, a beneficiary's unique condition and individual needs should be considered in deciding whether skilled nursing care is reasonable and necessary, without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period.
There is no palliative exclusion. There is no terminal exclusion. The skilled-need test asks whether the service is complex enough to require a professional — not what the prognosis is.
CMS closes the section with the conditional that governs everything:
Therefore, if the beneficiary meets the qualifications for coverage of services as set out at Sec. 409.42, he or she could receive palliative care services under the home health benefit, if ordered by an allowed practitioner.
Eligibility Still Gates Every Case
Read that conditional carefully, because it is doing real work. CMS did not say palliative patients are covered. It said that a beneficiary who meets the existing qualifications could receive palliative services under the benefit.
Those qualifications at 42 CFR 409.42 have not moved:
- The patient is homebound — leaving home requires considerable and taxing effort.
- There is a need for skilled care — skilled nursing on an intermittent basis, or physical therapy, or speech-language pathology.
- The services are under a plan of care established and periodically reviewed by an allowed practitioner.
- There has been a face-to-face encounter related to the primary reason for home health.
Every one of those still has to be documented, and the skilled need still has to be defensible on its own terms. "The patient has a serious illness" is not skilled need. "The patient requires skilled assessment and management of a complex symptom regimen that a caregiver cannot safely perform" is a claim you can defend.
What changed is not the standard. What changed is that CMS has said out loud that the prognosis is not the disqualifier — which removes an argument nobody should have been making in the first place.
Palliative Care Is Not Hospice
The confusion is understandable, because the two overlap clinically and diverge completely in benefit terms.
Hospice is a distinct Medicare benefit. The patient elects it, certifies a terminal prognosis, and in electing it generally waives Medicare payment for curative treatment of the terminal condition. Care is delivered by the hospice agency under the hospice per-diem.
Palliative care is a way of delivering care, not a benefit. It focuses on symptom burden and quality of life, and it can run alongside treatment intended to cure or control the disease. CMS makes exactly this point: because palliative care is "a method of care delivery that is provided throughout the continuum of illness, it can be furnished under various Medicare benefits."
A patient who has elected hospice is receiving care under the hospice benefit. A patient who has not elected hospice, and who meets home health eligibility, can receive palliative-oriented care under the home health benefit. They are different patients on different benefits, and an agency that treats "palliative" as a synonym for "hospice" is turning away referrals it is allowed to take.
Why CMS Is Raising This Now
This section exists because CMS is exploring the broader question. It included a Request for Information in the FY 2027 Hospice Wage Index proposed rule (91 FR 17359) asking for public input on "potential policy, operational, and payment approaches to strengthen and enhance the delivery of palliative care services outside of the hospice benefit."
CMS also states its view that "the home is an ideal environment for individuals to receive palliative care services, as remaining in the home during a serious illness may help alleviate psychological and mental distress and allow for more intimate caregiving to be provided by family members."
That is a direction of travel, not a rule. Nothing in the CY 2027 proposed rule creates a palliative care benefit, a palliative payment category, or a new coverage pathway. What it does is restate that the existing pathway was never closed.
What This Means Monday
Three practical consequences, in order of how quickly they bite.
Stop screening out on prognosis alone. If intake is declining referrals because the diagnosis is terminal or the illness is chronic and progressive, that screen is not grounded in the coverage rules. The question is whether there is a documented skilled need and whether the patient is homebound.
Write the skilled need as skilled need. The documentation risk on these patients is real, and it is not that palliative care is disallowed — it is that notes describing comfort and support read as custodial. If the clinical work is skilled assessment, medication management, symptom-regimen adjustment, or teaching a caregiver to manage a complex situation, the note has to say that in those terms.
Know which benefit the patient is on. Coordination between an agency and a hospice serving overlapping populations is where mistakes happen. A patient who elects hospice moves benefits, and that transition needs to be clean in your record.
The Bottom Line
CMS did not expand anything in this section. It clarified something that a lot of agencies had quietly gotten wrong: the home health benefit does not exclude patients because their illness is terminal, chronic, or long-running. Eligibility at 42 CFR 409.42 still governs, and skilled need still has to be documented and defensible.
But if the reason your agency does not take palliative referrals is that somebody once said it isn't allowed, that reason does not survive contact with the regulation.
Sources: Calendar Year 2027 Home Health Prospective Payment System Rate Update proposed rule, CMS-1844-P, section II.F, published 6 July 2026. Comments close 31 August 2026. Coverage requirements at 42 CFR 409.32(a) and 42 CFR 409.42. Medicare Benefit Policy Manual, Chapter 7 — home health services. Palliative care RFI at 91 FR 17359.