With deadline for reaching agreement on a spending package approaching on January 30, 2026, hospice providers should be prepared for the potential expiration of the telehealth face-to-face visits. LeadingAge encourages members to review upcoming face-to-face visits in the next 30 days and prioritize their completion either through in person or telehealth visits. If Congress does come to an agreement on the
current spending package proposal, the hospice face-to-face recertification via telehealth would be extended until December 31, 2027. The language includes guardrails first negotiated in late 2024 as part of a funding package which was never passed. The policies include first, a requiring the Centers for Medicare and Medicaid Services (CMS) to create, and providers to use, claims code modifiers when a visit is done via telehealth - this is something LeadingAge has advocated for across multiple comment periods. Second, the language outlines three specific of oversight specific guardrails for hospice use of virtual face-to-face visits; 1. The language would disallow hospices which serve individuals in an area subject to a moratorium on enrollment of hospice programs. As a reminder, there are currently no moratoriums on hospice enrollment anywhere in the US . However, it has been mentioned by Administration officials as a potential step to tamp down on fraudulent providers. 2. If the individual is receiving care, form a hospice under a Provisional Period of Enhanced Oversight (PPEO). Currently this would only effect new hospices, or hospices with 100% ownership change, in six states, AZ, CA, NV, TX, OH and GA. 3. If physician
OR nurse practitioner (NPs) performing the face-to-face is not enrolled in Medicare or properly opted out, virtual telehealth could not be used. Last year, as part of CMS updated policy, all physicians certifying hospice enrollment had to be formally enrolled or opt-ed out of Medicare for the hospice to bill. Adding NPs to this requirement would be new. Additionally, since the face-to-face is not a billable visit, if this language moves forward, CMS will need to update the requirements of the face-to-face to confirmation if the NP conducting the face-to-face is properly enrolled or outed out of Medicare. Given the recent scrutiny on hospice, LeadingAge is evaluating the potential impacts of these guardrails and talking to members of Congress and the Administration about the language.
