This bill amends section 1814(a)(7)(D)(i)(II) of the Social Security Act to extend existing Medicare telehealth flexibilities for hospice recertifications through December 31, 2027, where those flexibilities otherwise would have expired. It also creates targeted carveouts to the telehealth allowance beginning January 1, 2026, excluding recertifications for patients served by hospices in long-standing moratorium areas, hospices under enhanced oversight, or recertifications performed by certain non-enrolled hospice physicians and nurse practitioners.
In addition, the bill requires that, for recertification encounters occurring on or after January 1, 2026, hospice claims include one or more modifiers or codes (to be specified by the Secretary of HHS) that identify the encounter as conducted via telehealth. The change forces operational and billing updates for hospice providers and gives CMS a coded signal for monitoring telehealth recertifications while preserving telehealth access in most circumstances until the end of 2027.
At a Glance
What It Does
Extends the temporary Medicare hospice telehealth allowance referenced in section 1814(a)(7)(D)(i)(II) through December 31, 2027, and inserts three narrow exceptions effective January 1, 2026. It also mandates that hospice claims for recertifications held via telehealth include CMS-specified modifiers or codes beginning January 1, 2026.
Who It Affects
Medicare-certified hospice programs and clinicians who perform eligibility recertifications, Medicare administrative contractors that process hospice claims, and HHS/CMS for oversight and enforcement. Patients in hospice care will see continued telehealth access except where their provider is in a moratorium area or subject to enhanced oversight.
Why It Matters
The bill preserves telehealth recertification as an option for most hospice patients for nearly three more years while creating a billing-level identifier for telehealth encounters to aid CMS monitoring. It couples expanded access with program-integrity carveouts, shifting the compliance burden onto providers and claims processors.
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What This Bill Actually Does
The Hospice Recertification Flexibility Act makes two concrete changes to Medicare hospice rules. First, it pushes out the expiration date of a telehealth flexibility that treats certain recertification encounters as acceptable when done via telehealth, moving the sunset from March 31, 2025 to December 31, 2027.
That preserves the telehealth pathway for hospice recertifications for almost three additional years instead of letting it lapse in early 2025.
Second, starting January 1, 2026, the bill carves out three situations where the telehealth-recognition rule does not apply: (1) beneficiaries located in areas where hospice enrollment has been under a moratorium for at least six months under section 1866(j)(7); (2) beneficiaries receiving care from a hospice provider under enhanced oversight under section 1866(j)(3); and (3) encounters performed by hospice physicians or nurse practitioners who are not enrolled under section 1866(j) and who are not classified as "opt-out" clinicians under the existing cross-reference to section 1802(b)(6)(D). These carveouts are limited and targeted to situations where CMS already exercises extra scrutiny or where provider enrollment status raises integrity concerns.Finally, the bill requires a discrete billing change: any hospice claim that includes a recertification encounter conducted via telehealth on or after January 1, 2026 must carry one or more modifiers or claim codes that CMS will specify.
The statute does not itself list the codes or describe penalties for noncompliance; it leaves the substance of the coding rules and any enforcement to the Secretary. Practically, that means hospices must update billing and documentation workflows and ensure their contractors apply the appropriate modifier(s) to recertification claims to reflect telehealth use.
For CMS, the modifier provides a simple compliance signal for monitoring and audit targeting without immediately altering payment rates.
The Five Things You Need to Know
The bill amends 42 U.S.C. 1395f(a)(7)(D)(i)(II) to extend the hospice telehealth recertification flexibility’s sunset date from March 31, 2025 to December 31, 2027.
Beginning January 1, 2026, the telehealth recertification flexibility will not apply for beneficiaries in areas with hospice-enrollment moratoria in place for at least six months under section 1866(j)(7).
Beginning January 1, 2026, the telehealth recertification flexibility will not apply for beneficiaries receiving hospice services from providers subject to enhanced oversight under section 1866(j)(3).
Beginning January 1, 2026, recertification encounters conducted by hospice physicians or nurse practitioners who are not enrolled under section 1866(j) and who are not "opt-out" clinicians (per section 1802(b)(6)(D)) are excluded from the telehealth flexibility.
For recertifications on or after January 1, 2026, hospice claims must include one or more modifiers or codes—to be specified by the Secretary—to indicate the encounter was conducted via telehealth.
Section-by-Section Breakdown
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Short title
Labels the bill the “Hospice Recertification Flexibility Act.” This is a standard placement of a short title and has no operational effect on program rules; it simply identifies the act for citations and subsequent references.
Extend telehealth flexibility and add targeted exceptions
This amendment replaces the current statutory sunset with a later date (December 31, 2027) so that Medicare will continue to count certain recertification encounters done via telehealth as compliant under the cited provision. It also inserts three specific exceptions that begin January 1, 2026: (1) beneficiaries in geographic areas subject to hospice-enrollment moratoria for not less than six months; (2) beneficiaries of hospices under enhanced oversight; and (3) recertifications performed by hospice physicians or nurse practitioners who lack enrollment under section 1866(j) and are not classified as opt-out clinicians. The practical effect is to preserve telehealth access generally while removing the shortcut for contexts where CMS has flagged higher program-integrity risk.
Require telehealth modifier(s) on hospice recertification claims
Adds a condition that telehealth-recognized recertifications must be accompanied on hospice claims by one or more modifiers or codes that CMS will specify. The statute mandates the requirement but delegates the choice of codes and implementation details to the Secretary. For providers and payors, this is a billing compliance requirement: claims processors will need to accept and act on the modifier; hospices must capture and transmit it; CMS can use the code to filter and audit telehealth recertifications.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries in most areas: They retain the option to have hospice recertification encounters performed via telehealth through December 31, 2027, which reduces travel burden and may improve continuity of care for homebound or rural patients.
- Medicare-certified hospices that use telehealth: These providers keep a telehealth pathway for recertifications for nearly three additional years, allowing care models that rely on remote clinician visits to continue without reverting immediately to in-person-only recertifications.
- Clinicians (enrolled hospice physicians and nurse practitioners): Enrolled clinicians who meet the enrollment/opt-out criteria keep the ability to perform recertifications by telehealth, supporting workforce flexibility and scheduling efficiency.
- CMS and program integrity staff: The required modifier gives CMS a discrete claim-level marker to identify telehealth recertifications for monitoring, data analysis, and targeted audits.
Who Bears the Cost
- Hospice providers and their billing vendors: They must update claims systems, train staff, and change documentation practices to add the required telehealth modifier(s) and to implement the carveouts, which produces administrative and IT costs.
- Medicare administrative contractors (MACs) and CMS: These entities will need to accept, validate, and potentially act on the new modifier(s), update processing rules, and incorporate the data into oversight workflows.
- Beneficiaries served by hospices under moratoria or enhanced oversight: These patients will lose telehealth recertification access under the carveouts—potentially increasing travel, caregiver burden, or delays in recertification.
- Non-enrolled clinicians who previously performed recertifications via telehealth: Clinicians who are not enrolled under section 1866(j) and not classified as opt-out will no longer have recertifications recognized under this telehealth flexibility, disrupting existing arrangements.
Key Issues
The Core Tension
The central dilemma is access versus program integrity: the bill sustains telehealth recertifications for most beneficiaries to preserve convenient, continuous hospice care, while simultaneously erecting targeted exclusions and a claims-level identifier to curb misuse—forcing policymakers to balance preventing fraud and poor-quality providers against avoiding undue disruption to legitimate telehospice services.
The bill threads a narrow needle: it keeps telehealth recertification broadly available while carving out situations where CMS already has integrity concerns. That approach raises implementation questions.
First, the statute requires modifiers or codes but leaves the universe and structure of those codes to the Secretary; CMS will need to issue guidance or rulemaking that defines which codes to use, whether multiple modifiers are allowed, and whether missing or incorrect modifiers will trigger denials or audits. The timing matters: hospices and vendors will need sufficient lead time to update claims platforms ahead of the January 1, 2026 effective date for the modifier requirement.
Second, the carveouts will create uneven access. Beneficiaries in moratorium areas or under hospices with enhanced oversight will face stricter recertification requirements, which may be appropriate from an integrity standpoint but could create geographic pockets where telehealth access for end-of-life care is curtailed.
The bill does not specify transition protocols, exceptions, or grandfathering for patients mid-course, nor does it address state licensure or cross-state telehealth constraints that already complicate telehospice delivery. Finally, because the statute does not alter payment rates or create explicit penalty language for missing modifiers, enforcement will rely on administrative policy; that leaves open questions about whether CMS will treat the modifier as a hard condition for payment or as a reporting field used primarily for analytics and audit targeting.
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