Medicare Pilot Program Launches Community Palliative Care for Seriously Ill, Must Start Within One Year

The Expanding Access to Palliative Care Act is setting up a major shift in how Medicare handles serious illness. Essentially, this bill tells the Center for Medicare and Medicaid Innovation (CMI) to ditch the old models and create a brand-new, five-year pilot program focused on community-based palliative care. The goal? Give people with serious conditions better care where they live, improve their quality of life, and cut down on expensive, often unwanted, trips to the emergency room or hospital.

The New Care Model: Palliative Care at Home

This isn't about hospice, though they’re related. Palliative care focuses on managing pain, symptoms, and stress for anyone with a serious diagnosis—like cancer, heart disease, or Alzheimer’s—regardless of where they are in their illness. The bill mandates that this new model must start within one year and target anyone enrolled in Medicare Part A (hospital insurance) who has a serious illness. Crucially, the bill specifies that if you’ve used hospice benefits before, you can’t be excluded from this new palliative program. This is huge because it means support doesn’t have to stop just because a patient previously sought end-of-life care.

Who Delivers the Care, and Where

The care will be provided by a multi-disciplinary team—think doctors, nurses, social workers, and counselors—who must work in “co-management” with the patient’s primary care doctor. To ensure quality, at least one person on the team must be certified in hospice and palliative care. This team approach is key to making sure everything from pain management to advance care planning is covered. The best part for patients and their families? Care can be delivered wherever they are comfortable: their own home, a caregiver’s home, or an extended care facility. The bill also requires that if a patient is hospitalized, the palliative care services must continue, ensuring a smooth transition back home and preventing care from falling apart during a crisis.

Making Sure Everyone Gets Access

If you live in a rural area or an underserved community, this bill pays special attention to you. The CMI is mandated to focus on ensuring that people in these areas have just as much access to this 24/7 care—which includes telehealth services—as those in urban centers. For someone juggling a full-time job and caring for a parent with congestive heart failure in a small town, this means coordinated support, symptom relief, and advice are available around the clock without having to drive hours to a specialist.

The Bottom Line: Costs and Coordination

Medicare will measure the success of this pilot by comparing participants to similar patients not in the program. They’ll be looking closely at how often people go to the ER or get admitted to the hospital, and how long they stay in hospice care. While the explicit goal is improving quality of life, the metrics are clearly focused on reducing expensive acute care utilization. This means the participating care teams will be incentivized to manage symptoms aggressively and proactively at home. While this is great for cost savings, we need to make sure the evaluation also captures those less quantifiable quality-of-life improvements, not just the money saved. Overall, this bill is a smart move toward making complex illness management more humane and accessible, allowing people to receive high-quality support in their community rather than navigating the chaos of the hospital system.