House Proposal Extends Hospice Face-to-Face Flexibility

House Proposal Extends Hospice Face-to-Face Flexibility

Home» House Proposal Extends Hospice Face-to-Face Flexibility

The House Ways and Means Committee will mark up a number of health-related bills on May 8. Among them is the "Preserving Telehealth, Hospital, and Ambulance Access Act," which includes an extension of the flexibility to allow hospices to perform the face-to-face recertification via telehealth through December 31, 2026. However, the language reauthorizing this flexibility contains some new caveats on the use of telehealth for the face-to-face recertification in response to ongoing program integrity concerns in the hospice program. Circumstances under which an individual must be recertified in person under this proposal include:

• If an individual lives in an area that is subject to a moratorium on the enrollment of hospice programs under SSA §1866(j)(7). No area is under a moratorium via this authority currently; LeadingAge does support temporary, targeted moratoriums to help combat fraudulent hospices.
• If an individual is receiving hospice care from a provider that is subject to enhanced oversight under §1866(j)(3). Currently, new providers in California, Nevada, Arizona, and Texas are subject to enhanced oversight under §1866(j)(3) so would have to recertify patients in person.
• If the recertification encounter is performed by a physician or nurse practitioner who is not enrolled in Medicare or formally opted out. Medicare finalized this requirement in the FY2024 hospice rule for physicians certifying patients for hospice, it goes into effect on June 3, 2024. This provision in the legislation explicitly formalizes this for the face to face requirement to be done via telehealth.

In addition, the legislation contains a provision that would instruct CMS to create modifiers and/or codes as is necessary to track that the encounter occurred via telehealth. Encounters must be modified or coded in this way starting two years after the enactment of this law.

More details on other aspects of this bill can be found here.