Federal Legislation Extends Telehealth Face-to-Face Encounters Through 2027: What Home Health and Hospice Providers Must Know

FOR IMMEDIATE RELEASE

Federal Legislation Extends Telehealth Face-to-Face Encounters Through 2027: What Home Health and Hospice Providers Must Know

Los Angeles, CA – Recent federal budget legislation has officially extended the allowance for conducting Medicare-required Face-to-Face encounters via telehealth for both home health and hospice providers through December 31, 2027. This extension provides continued operational flexibility, but it also introduces new compliance requirements that agencies must understand immediately to mitigate regulatory risk.

According to updates issued following passage of the federal budget resolution and subsequent CMS guidance, home health agencies may continue utilizing telehealth for Face-to-Face encounters consistent with existing regulatory standards under 42 CFR §484.22. Under the current final rule, home health agencies may accept Face-to-Face documentation from any qualified physician or non-physician practitioner, provided the encounter meets all statutory criteria for timing, content, and documentation.

While home health processes largely remain unchanged, hospice providers face additional scrutiny.

Under 42 CFR §418.22, hospice Face-to-Face encounters conducted via telehealth are now subject to specific statutory limitations.

The first limitation restricts telehealth Face-to-Face encounters for any hospice operating in a state under a federal enrollment moratorium. At this time, there are no active federal moratoria in effect nationwide. However, CMS maintains statutory authority under 42 U.S.C. §1395hh(j) to impose temporary enrollment moratoria when deemed necessary to prevent fraud, waste, or abuse. Industry observers are closely monitoring developments, particularly in light of recent public discussions by CMS leadership regarding potential moratorium activity.

The second restriction applies to hospices placed under Provisional Enhanced Oversight, commonly referred to as PPEO. Any hospice agency currently subject to PPEO may not conduct Face-to-Face encounters via telehealth. Importantly, this restriction applies to the individual agency placed under oversight, not all providers operating within a state.

PPEO designation commonly affects newly Medicare-certified hospices, agencies that have undergone a Change of Ownership triggering enhanced oversight, or providers reactivated after Medicare deactivation. PPEO oversight is currently active in California, Arizona, Nevada, Texas, Georgia, and Ohio. Agencies operating in these states should conduct immediate internal reviews to determine their enrollment status.

A third nationwide requirement mandates that any physician or nurse practitioner conducting a hospice telehealth Face-to-Face encounter must be enrolled in the Provider Enrollment, Chain, and Ownership System, known as PECOS. While physicians have long been required to maintain PECOS enrollment for billing validation, the claims system does not automatically verify nurse practitioner enrollment status in connection with hospice claims. Going forward, agencies must proactively verify PECOS enrollment for any NP performing telehealth Face-to-Face encounters.

Verification may not occur at claims submission but will be reviewed during medical review activities. These reviews may be initiated through Additional Documentation Requests, Unified Program Integrity Contractor investigations, Medicare Administrative Contractor audits, Supplemental Medical Review Contractor reviews, or other oversight entities. During those reviews, auditors will validate that the provider conducting the telehealth encounter was properly enrolled in PECOS at the time of service.

Another operational change affecting every hospice nationwide will take effect January 1, 2027. Claims will be required to include a specific code identifying when the associated Face-to-Face encounter was conducted via telehealth. CMS has not yet issued detailed instructions regarding whether this will be implemented as an occurrence code, condition code, modifier, or other claims element. Additional transmittals and claims processing guidance are expected prior to implementation.

Industry experts caution that while telehealth flexibility has been extended, documentation scrutiny will likely increase. Agencies should ensure that:

• Face-to-Face timing requirements are strictly met
• Documentation clearly supports continued eligibility
• Telehealth modality is documented appropriately
• PECOS enrollment is verified and retained in compliance files
• Claims processes are updated in advance of 2027 coding changes

Failure to meet these requirements may expose agencies to payment recoupments, denials, or corrective action during audits.

This legislative extension provides stability for providers navigating workforce shortages and access challenges, but it simultaneously reinforces CMS’s continued emphasis on program integrity.

Home health and hospice agencies are encouraged to conduct immediate compliance reviews of their Face-to-Face processes and telehealth documentation policies to ensure alignment with federal requirements.

HealthBridge Consulting stands ready to assist Medicare-certified home health and hospice providers with regulatory interpretation, audit defense, documentation systems, internal compliance audits, and PPEO navigation. Agencies seeking proactive compliance support may contact HealthBridge for consultation and operational review services.

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About HealthBridge Consulting

HealthBridge provides regulatory, operational, and compliance consulting services to Medicare-certified home health, hospice, assisted living, and skilled nursing providers. The firm specializes in Conditions of Participation compliance, program integrity audits, ADR response management, and organizational governance systems.

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