The "Hospice Recertification Flexibility Act" extends Medicare telehealth flexibilities for hospice care through 2027 and requires a modifier for telehealth recertifications starting in 2026.
Carol Miller
Representative
WV-1
The "Hospice Recertification Flexibility Act" extends Medicare telehealth flexibilities for hospice care through December 31, 2027, with certain limitations after January 1, 2026, based on location, provider oversight, and proper enrollment. It also mandates the use of specific modifiers or codes on hospice claims to identify when recertifications of hospice care eligibility are conducted via telehealth starting January 1, 2026.
Medicare Extends Telehealth for Hospice Care to 2027, But Adds New Rules
The "Hospice Recertification Flexibility Act" is making some changes to how telehealth can be used for hospice care under Medicare. Here's the breakdown:
Telehealth Stays, With Some Twists
This bill extends the ability for folks on Medicare to use telehealth for some hospice care services. Originally set to expire, these flexibilities are now good through December 31, 2027. This is a big deal for people in rural areas or those who have trouble getting to in-person appointments. Think of a family in a small town caring for a loved one at home – telehealth can make a huge difference in getting the support they need. (SEC. 2)
But there's a catch, starting January 1, 2026, there are some new restrictions:
- Location Matters: If you're in an area where there's a temporary hold on new hospice providers (a "moratorium") for six months or more, these telehealth flexibilities might not apply. (SEC. 2)
- Provider Oversight: If your hospice provider is under "enhanced oversight" (meaning they're being watched more closely), telehealth might be limited. (SEC. 2)
- Doc Enrollment: The doctor or nurse practitioner providing care via telehealth needs to be properly enrolled in Medicare, or this extension won't cover them. (SEC. 2)
Keeping Track: New Codes for Telehealth
Another key change is how telehealth visits will be tracked. Starting January 1, 2026, any hospice claim that involves recertifying someone's eligibility for hospice care via telehealth will need a special modifier or code. This is basically a flag on the paperwork that says, "This was done through telehealth." (SEC. 3)
Why does this matter? It helps Medicare keep a closer eye on how telehealth is being used in hospice care. Think of it like adding a note to your file – it gives more context to what's happening. While it's good for transparency, it does mean a bit more paperwork for providers.
The Big Picture
This bill is a mixed bag. On one hand, it keeps telehealth as an option for hospice care, which can be a lifeline for many families. On the other hand, it adds some hoops to jump through, depending on where you live and who your provider is. It aims to balance access with oversight, which is always a tricky balancing act. For example, imagine a nurse practitioner who can't easily visit a remote patient; telehealth helps, but only if all the new enrollment and location rules are followed. The added coding also helps track telehealth use, but it's another step for already busy healthcare workers.
The "Hospice Recertification Flexibility Act" tries to keep things flexible while also putting some guardrails in place. Whether it hits the mark will depend on how these changes play out in the real world.