https://www.hnmd.org/news/default.asp Mon, 27 Jul 2026 07:53:11 GMT Wed, 15 Jul 2026 19:05:00 GMT Copyright © 2026 Hospice & Palliative Care Network of Maryland https://www.hnmd.org/news/news.asp?id=731223 https://www.hnmd.org/news/news.asp?id=731223 Full article here

While recent actions by the U.S. Centers for Medicare & Medicaid Services (CMS) could incrementally move the needle on palliative care access, they could also come with many limitations. 

CMS in its proposed 2027 home health rule clarified that home health providers can use certain billing codes to provide community-based palliative care to eligible patients. The agency emphasized that this palliative care would be distinct from hospice.

Stakeholders in the hospice community were quick to applaud the proposal.

“We are pleased to see CMS recognize the value of palliative care and the important role it plays in improving quality of life for people living with serious illness both before hospice election and during it,” National Partnership for Healthcare and Hospice Innovation Founder and CEO Tom Koutsoumpas told Hospice News in an email. “NPHI has long advocated for greater access to, and sustainable payment for, palliative care services much earlier and throughout the course of serious illness, and we welcome CMS’s openness to advancing this work as an important step toward ensuring access for patients and families.”

The clarification in the proposed rule does not represent new policy or practices by CMS. The agency indicated that it would release further sub-regulatory guidance later this year on how home health agencies can provide palliative care.

However, what CMS has done falls short of a community-based palliative care benefit. For one, patients must meet the eligibility requirements for home health. This means that, among other requirements, patients must be homebound to receive this care, according to Katy Barnett, director of hospice and home health operations and policy for LeadingAge. This excludes many patients who may benefit from palliative care. 

This also means that hospices with community-based palliative care programs cannot bill using those codes unless they have a Medicare-certified home health service.

The palliative care model that exists within home health is also somewhat less robust than the services provided by hospices, Barnett indicated.

“We do believe that home health is a good place for palliative care patients. I think one of the things that we’re struggling with is that, if we push palliative care into home health, the benefit really doesn’t support the same intensity of care as the hospice program,” Barnett told Hospice News. “It’s a really tight payment, and that’s why you see so few new home health agencies. It’s a really tough industry to be in right now, especially with the last four years of [payment] cuts.”

Existing quality measures for home health also do not incentivize the provision of palliative care. CMS evaluates home health largely on improvement measures that show a patient’s progression towards a recovery. They are not built for maintenance or comfort care, Katie Wehri, vice president for regulatory affairs, quality and compliance at the National Alliance for Care at Home. 

“[Quality measurement] is an area where there needs to be some more work. The payment structure needs to be revised, but the quality structure does as well,” Wehri told Hospice News. “Those quality measures aren’t really aligned to the typical patient who’s going to be receiving palliative care services, or even the typical patient who is more of a maintenance patient rather than a patient who’s there for skilled rehab services.”

Wehri posits that the home health payment model does not cover the full range of interdisciplinary care that a hospice might provide, including chaplain service and more frequent social worker visits. She also said that the payment model needs to be updated to reflect the more acute level of care that palliative patients often need. 

Also, the home health benefit does not require collaboration with a medical or advanced practice provider, according to Brynn Bowman, CEO of the Center to Advance Palliative Care (CAPC) and Allison Silvers, chief healthcare transformation officer at CAPC.

“The home health team should have a formal collaboration with a qualified palliative care medical or advanced practice professional,” Bowman and Silvers told Hospice News in a joint email. “This is aligned with palliative care quality guidelines and CMS should clarify that the medical provider can bill Part B while the home health is billing Part A.”

All in all, stakeholders recognize this move by CMS as a positive step. But many also feel that further reforms or additional access points are necessary to truly meet the needs of patients who could benefit from palliative care.

“I definitely think that acknowledging that palliative care services are part of home health is a step in the right direction,” Wehri said. “It is not where we need to be fully. We’ve got to take some steps to look at serious illness throughout the continuum of care, not just for those homebound patients.”
]]> Wed, 15 Jul 2026 20:05:00 GMT https://www.hnmd.org/news/news.asp?id=725141 https://www.hnmd.org/news/news.asp?id=725141 Full article here

Two of the nation’s three largest hospice trade organizations decried a proposed 2.4% hospice base rate increase as inadequate in today’s financial climate, with one saying it could provide “modest stability.”

The U.S. Centers for Medicare & Medicaid Services (CMS) on Thursday issued its proposed payment rule for hospices in 2027 containing a 2.4% payment increase. If finalized, this would result in a $785 million payment boost from Fiscal Year 2026.

The amount of the proposed pay raise puts the sustainability of hospice care in jeopardy, according to Linda Couch, senior vice president for policy at LeadingAge.

“The rule’s proposed payment rate update of 2.4% barely keeps up with inflation,” Couch said in a statement. “Payment that scarcely covers the cost of services delivered threatens the ability of quality-focused, mission-driven providers to deliver needed care and potentially limits access for those who seek it.”

The rate of inflation in the United States for the 12 months ending in February 2026 was 2.4%, according to the U.S. Bureau of Labor Statistics. Nevertheless, hospices are feeling the squeeze, particularly when it comes to labor costs.

“The proposed 2.4% payment update – largely prescribed by law – will still result in challenges for providers delivering care. Cost pressures continue to mount from factors like inflation, workforce shortages, and rising expenses for supplies and services,” the National Alliance for Care at Home indicated in a statement. “While the Alliance appreciates that CMS is recognizing hospice providers’ difficult operating environment, this update – after several years of inadequate payment adjustments – will still leave difficulties for providers delivering this vital benefit to the patients and families who depend on it.”

Many providers have been experiencing margin compression in recent years.

The average Medicare fee-for-service margin for hospices fell to 8% in 2023, down from 9.8% in 2022 and 14.2% in 2020, according to the Medicare Payment Advisory Commission (MedPAC). Among for-profit providers, the average 2023 margin was 13.7%, whereas nonprofits in aggregate showed a loss at -1.3%. These numbers exclude cap overpayments and non-reimbursible costs.

These declines occurred during a time of record-breaking demand. Hospice utilization in 2024 reached the highest rate it has ever seen at 53%, MedPAC reported. More than 1.8 million Medicare decedents received hospice care that year for a total of 148 million days of service.

The Alliance and LeadingAge are continuing to evaluate other aspects of the proposed rule and will likely file public comments on its provisions to CMS in the coming months.

Additional provisions in the proposed rule include an analysis of Medicare spending outside hospice care during a hospice election, including specifics on a Hospice Service and Spending Variation Index (SSVI). The SSVI would use a scoring system based on nine claims-derived measures, each reflecting different facets of hospice utilization and non-hospice expenditures. The aim is to flag hospices that may require greater transparency and oversight.

Any regulatory updates or new rules would have to be balanced against the burden it could put on providers, according to Tom Koutsoumpas, founder and CEO of the National Partnership for Healthcare & Hospice Innovation (NPHI).

“NPHI appreciates CMS’s continued focus on strengthening hospice program integrity and transparency in the FY 2027 proposed rule. In light of increased focus on fraud, waste, and abuse in the hospice benefit, it is encouraging to see CMS proposing meaningful steps to enhance oversight,” Koutsoumpas told Hospice News in an email. “While the proposed payment update offers modest stability, it will be important to ensure that new oversight and reporting policies are appropriately targeted and do not create unintended burdens for high-quality, mission-driven providers.”

The rule also proposes regulatory changes that would allow a physician designee and the physician member of the interdisciplinary group—alongside the hospice medical director—to discharge a patient from hospice care.

It further seeks input on expanding community-based palliative care services within existing Medicare benefits, creating a hospice-specific wage index using data from the U.S. Bureau of Labor Statistics, and examining the overlap between hospice care and medical aid in dying.

In addition, the proposal suggests adding an icon to the Medicare Care Compare website to flag providers that fail to meet Hospice Outcomes and Patient Evaluation (HOPE) reporting requirements.

It also would make it mandatory for hospices to provide patients and families with an addendum to the election statement, a document that is currently supplied only upon request.

The Alliance voiced support for actions that would strengthen program integrity while cautioning CMS about potential unintended consequences for legitimate providers.

“Hospice care is an invaluable part of the Medicare program, with evidence demonstrating that it is the preferred choice by patients and families when appropriate. While a 2.4% payment increase is a step in the right direction, more must be done to ensure that high-quality providers have the resources they need to operate in this demanding environment,” said Jennifer Sheets, CEO of the Alliance, in a statement. “The Alliance appreciates the increased oversight and transparency proposals but calls on CMS to carefully implement these measures to avoid unintended consequences for patients and providers. We must protect this essential service so every American can receive compassionate, dignified care at the end of life.”]]> Fri, 10 Apr 2026 00:25:00 GMT