Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its highly anticipated proposed payment rule for the 2027 home health year, and buried in the hundreds of pages of regulatory language is something that could fundamentally change how Medicare supports families managing chronic and serious illness at home.
For the first time, CMS is formally proposing to integrate palliative care principles into the Medicare home health benefit. Alongside this landmark shift, the agency is also proposing stronger quality measures, expanded telehealth flexibilities, new integrity measures to combat fraud, and a renewed emphasis on patient and caregiver experiences.
If you are caring for a loved one with a chronic condition like heart failure, COPD, Parkinson's disease, or dementia — or if you are navigating home health for a serious or advanced illness — these changes matter to you. Here is a breakdown of what is being proposed, what it means for your family, and how to make the most of the home health benefit as it evolves.
The Big Shift: Palliative Care Comes to Medicare Home Health
The most talked-about proposal in the CY 2027 home health rule is CMS's move to formally recognize and reimburse palliative care within the Medicare home health benefit. This is a major departure from the traditional view of home health as a strictly recovery-oriented service.
Palliative care is often misunderstood. Many families assume it is the same as hospice, but it is not. Hospice care is for people with a terminal prognosis who have chosen to stop curative treatment. Palliative care, by contrast, is specialized medical care for people living with serious illness — at any stage, including while they continue to pursue curative treatments. Its goal is to improve quality of life by managing symptoms, controlling pain, addressing emotional and spiritual needs, and supporting family caregivers.
As reported by Hospice News in their coverage of the CMS proposed rule, the agency's new framework would define how home health agencies can provide palliative-focused services to patients who need symptom management and coordinated care but do not yet qualify for hospice. This closes a long-standing gap in Medicare coverage: patients with serious illness who are not yet ready for — or don't qualify for — hospice have often fallen into a coverage gray zone where their needs are too complex for traditional home health but their prognosis does not meet hospice criteria.
Under the proposed rule, a formal palliative care pathway within home health would mean:
For the millions of families managing a loved one with a serious chronic illness, this change could mean the difference between struggling through uncontrolled symptoms alone and having a professional team that proactively manages quality of life.
Improving the Beneficiary Experience: What Commonwealth Fund Research Reveals
The timing of CMS's proposed rule is notable. Just days before the rule was released, the Commonwealth Fund published two major analyses that shed light on where Medicare home health falls short from the patient and family perspective.
The first article, "Improving Access to Medicare Home Health Care: Key Policy Considerations," identified several persistent barriers that prevent eligible patients from receiving home health services. These include lack of awareness of the benefit among both families and physicians, inadequate supply of providers in rural areas, and administrative hurdles like prior authorization requirements in Medicare Advantage plans.
The second article, "Improving Medicare's Home Health Benefit: Beneficiary Experiences and Priorities," went straight to the source — interviewing patients and families about their actual experiences with home health. The findings were striking. Beneficiaries consistently identified three priorities that the current system does not reliably deliver:
The CMS proposed rule appears to be responding directly to these concerns. New proposed quality measures would track things like whether patients' goals and preferences are documented and honored, whether the care plan is shared with the patient and family in a way they understand, and whether patients report that their symptoms are well controlled.
Stronger Integrity Measures: Protecting Families from Fraud Without Blocking Access
No discussion of CMS's 2027 rule would be complete without addressing the proposed enrollment integrity measures. As reported by MedLearn Publishing in early July, CMS is proposing tougher Medicare enrollment rules for home health agencies — including more extensive background checks, site visits before enrollment, and faster revocation authority for agencies that pose a fraud risk.
This is a direct response to a troubling pattern. Home health fraud — including billing for services never rendered, falsifying patient records, and identity theft — has been a persistent problem that costs Medicare billions of dollars each year. The Government Accountability Office has repeatedly flagged home health as one of the highest-risk areas for improper payments.
For families, the proposed integrity measures are a double-edged sword. On the positive side, tougher enrollment rules mean fewer fly-by-night agencies and more accountability across the industry. Patients and their families can have more confidence that the agency they choose is legitimate, properly staffed, and subject to real oversight.
But there is a risk that overly aggressive enrollment restrictions could reduce the number of available home health agencies — especially in rural and underserved areas where only a few agencies operate. CMS has acknowledged this tension and is seeking comment on how to balance fraud prevention with access to care. Families and providers have until late summer 2026 to submit comments before the rule is finalized.
Expanded Telehealth and Remote Monitoring: A Permanent Shift
Another significant proposal in the 2027 rule is the permanent expansion of telehealth and remote patient monitoring within the home health benefit. During the COVID-19 public health emergency, CMS temporarily allowed home health agencies to use telehealth for supervisory visits, care coordination, and some patient encounters. The 2027 proposed rule would make many of those flexibilities permanent.
For families, this means:
Telehealth is not a replacement for in-person home health care. Skilled nursing and therapy services will always need to be delivered in the home to be effective. But as a supplement, telehealth can close the gaps between visits and give families more confidence that someone is watching over their loved one even when no one is in the house.
What This Means for You: Practical Takeaways for Families
With all these changes on the horizon, what should families who need home health care right now do? Here are practical steps to take today.
**Stay informed about the proposed rule.** The public comment period for the CY 2027 home health proposed rule runs through late summer. If you or your loved one has a story about how Medicare home health could be improved — or about barriers you have faced accessing care — consider submitting a comment. CMS reads every comment, and patient and family voices carry real weight.
**If your loved one has a serious or chronic illness, ask about palliative approaches.** Even before the proposed rule is finalized, many Medicare-certified home health agencies already incorporate palliative care principles into their practice. Ask your home health agency whether they provide symptom management, pain control, and caregiver education as part of their standard care — these are services that can make a real difference in quality of life.
**Know your rights under existing law.** The Jimmo settlement already guarantees that Medicare covers skilled home health care for maintenance, not just improvement. If your loved one has a progressive or chronic condition and has been told they "don't qualify" because they won't get better, ask specifically about the Jimmo standard. You may be entitled to care you were never told about.
**Check quality ratings before choosing an agency.** As CMS sharpens its focus on patient experience and quality outcomes, agencies with high star ratings and strong patient satisfaction scores are likely to deliver better care. Use Medicare's Home Health Compare tool to evaluate agencies in your area before making a decision.
The Road Ahead: Home Health Care That Matches What Families Actually Need
The CMS 2027 proposed rule represents the most significant rethinking of the Medicare home health benefit in years. The move to integrate palliative care, the emphasis on patient experience, the permanent expansion of telehealth, and the stronger integrity measures all point in the same direction: toward a home health system that is more responsive to what patients and families actually need.
But rules and proposals only matter if families know about them and can use them. Medicare home health remains one of the most valuable — and most underused — benefits available to older Americans. Whether your family is navigating a new diagnosis, managing a long-term chronic condition, or planning ahead for the possibility of needing care, understanding how the benefit is evolving gives you the knowledge to advocate effectively for your loved one.
At Home Health Plan Finders, we help families across the country understand their Medicare home health options every day. Our care advisors stay current on CMS rule changes, coverage updates, and quality ratings so you do not have to. Whether you are trying to find a home health agency that offers palliative care, need help appealing a denial, or simply want to compare your coverage options, we are here to help.
Visit homehealthplanfinders.com/get-quote for free, personalized guidance. No cost, no obligation — just honest, caring advice from people who understand what families like yours are going through.