Telehealth Flexibilities Update – Quality and Compliance

On February 3, 2026, Congress passed and the President signed the Consolidated Appropriations Act, 2026 ending the government shutdown. This legislation includes Continuing Resolution (CR) which funds most of the government through September 30, 2026. In addition to funding the government, the legislation includes several provisions important to the care at home community, including the extension of telehealth, as outlined below.

The Alliance is pleased to see an extension of telehealth flexibilities through December 31, 2027; however, we are concerned about the implementation of the limitations on the use of telehealth for the face-to-face encounters for some hospices.  The Alliance recognizes that it will take some time for CMS to implement the parameters and we spoke to CMS about this today. In that discussion, CMS indicated that the Agency needs to think through implementation and will try to provide as much notice as possible before anything goes in place for these new telehealth guardrails. The Alliance is working to make this as seamless as possible for providers and will provide updates as they become available.

Sec 6101: Streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP:

This section creates a new requirement for states to establish a streamlined enrollment process for providers who are serving individuals under age 21 in a different state than their primary Medicaid enrollment. States would be required to offer out-of-state providers an expedited enrollment if they are: serving an individual under age 21; deemed ‘limited risk’ by either CMS/HHS or the state Medicaid agency that they are enrolled in; and not subject to any exclusion from Federal or State health care programs. Notably, it is unclear whether any home care providers would qualify as home health and hospice are deemed ‘moderate risk’ by CMS and states are not allowed to classify providers at a lower level of risk than CMS. Similarly, personal care, private duty nursing, and other non-Medicare home care providers are largely classified as moderate or high risk under the state programs.

Sec. 6102. Removing certain age restrictions on Medicaid eligibility for working adults with disabilities:

Modifies the Medicaid Buy-in program for working adults with disabilities to allow eligibility for individuals older than 65.

Sec 6103: Medicaid State plan requirement for determining residency and coverage for military families:

Beginning 2030, states would be required to maintain Medicaid eligibility for an individual (or family member of the individual) who is enlisted in the armed forces and must relocate out of the state due to their enlistment orders and who is receiving home and community-based services (HCBS). Individuals on HCBS waiver waiting lists would be maintained at their spot on the list post relocation. HHS is directed to issue guidance on how to effectuate coverage in the new state.

Sec 6207: Extension of funding for Medicare hospice surveys:

Appropriates an additional $4.4M through the end of this calendar year, to remain available until expended, for hospice surveys. This is an extension of the funding originally included in the IMPACT Act of 2014, which expired at the end of fiscal year 2025.

Sec 6209: Extension of Certain Telehealth Flexibilities:

1. For home health providers, it extends provisions removing geographic requirements and expanding originating sites through December 31, 2027. This allows the required face-to-face visit (F2F) to be performed via telehealth
2. For hospice providers, it extends the hospice F2F telehealth flexibility through December 31, 2027; however, telehealth is NOT permitted, beginning January 31, 2026, if:
   1. the individual receiving hospice is located in an area subject to a CMS moratorium on enrollment of hospice programs;
   2. the individual is receiving hospice care from a provider subject to the Provisional Period of Enhanced Oversight (PPEO); or
   3. the encounter is performed by a hospice physician or nurse practitioner who is not enrolled in Medicare and is not an opt-out physician or practitioner.
3. For hospice providers, requires CMS to create a claims modifier or code to indicate if a F2F encounter was conducted via telehealth starting January 1, 2027.

Sec. 6210 Extending Acute Hospital Care at Home Waiver Flexibilities

1. Extends the Acute Hospital Care at Home waiver flexibilities through September 30, 2030. 
2. Requires that not later than September 30, 2029, the Secretary shall conduct a study to- ”(A) analyze, to the extent practicable, the criteria established by hospitals under the Acute Hospital Care at Home initiative to determine which individuals may be furnished services under such initiative; and ”(B) analyze and compare (both within and between hospitals participating in the initiative, and relative to comparable hospitals that do not participate in the initiative, for relevant parameters such as diagnosis-related groups
3. Requires a report on the study to be submitted to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate not later than September 30, 2029.  The report is to also be made publicly available.
4. In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $2,500,000, to remain available until expended, for purposes of carrying out the study and report.

Sec 6218: Extension of adjustment to calculation of hospice cap amount under Medicare:

1. Extends the IMPACT Act of 2014’s hospice cap amount update formula. Instead of increasing the hospice cap amount by the CPI-U, the cap amount is instead updated by the annual payment update percentage for years 2034 and 2035. This change is estimated to decrease the annual increase to the hospice cap.

Resources: Telehealth Flexibilities Update- January 30, 2026 | Quality and Compliance