Earlier today, Congressional leaders announced an agreement had been struck on the remaining appropriations bills and health extenders, including telehealth provisions. The text of the Consolidated Appropriations Act, 2026, contains many measures relevant to the care at home community.
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:
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For home health providers, it extends provisions removing geographic requirements and expanding originating sites through December 31, 2027. This allowsthe required face-to-face visit (F2F) to be performed via telehealth
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For hospice providers, it extends the hospice F2F telehealth flexibility through December 31, 2027; however, telehealth is NOT permitted, beginning January 31, 2026, if:
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the individual receiving hospice is located in an area subject to a CMS moratorium on enrollment of hospice programs;
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the individual is receiving hospice care from a provider subject to the Provisional Period of Enhanced Oversight (PPEO); or
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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.
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Requires CMS to create a claims modifier or code to indicate if a F2F encounter was conducted via telehealth starting January 1, 2027.
Sec 6218: Extension of adjustment to calculation of hospice cap amount under Medicare:
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 the annual increase to the hospice cap amount and is used as a "pay-for" for the broader health package. We do not yet have an estimate on the cost of this provision.
The current plan is to bring this legislation to a vote in the House of Representatives later this week, and if passed, to the Senate next week. The situation is still fluid and may change. The Alliance will continue to keep members up to date with the latest information and advocate for provisions that support effective delivery of home-based care.
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Logan Hoover
Vice President of Policy and Government Relations
National Alliance for Care at Home
lhoover@allianceforcareathome.org------------------------------