A bill currently before Congress would extend through 2026 regulatory flexibilities related to telehealth, including the ability to recertify patients for hospice care.

If enacted, the Preserving Telehealth, Hospital, and Ambulance Access Act, would as of 2025 extend the flexibilities by two years. It also includes some exceptions. If a hospice is undergoing a period of enhanced oversight by the U.S. Centers for Medicare & Medicaid Services (CMS), they would not be able to recertify via telehealth. Also, clinicians who are not enrolled in Medicare or who validly opted out would likewise be prohibited.

The U.S. House of Representatives Ways & Means Committee marked up the bill in a hearing this morning. While this bill would represent a two-year extension, some lawmakers expressed a will to make the flexibilities permanent.

“I’m of the view that telehealth ought to be perhaps a permanent part of Medicare, but recognize the merit to additional study and consideration of telehealth utilization, and specifically, guardrails,” Rep. Mike Thompson (D-Calif.) said. “We have an obligation to be responsible stewards of taxpayer dollars, and there are ways this committee can work to ensure that Medicare pays for telehealth in high-value settings, avoids unnecessary utilization and has robust anti-fraud and anti-abuse measures in place.”

During the COVID-19 public health emergency, CMS allowed hospices to perform routine home care visits virtually, as well as conduct face-to-face recertification visits. Congress later extended that flexibility through Dec. 31, 2024.

While patients in any community could potentially benefit from telehealth, access is particularly important for residents in rural areas who may live long distances away from their health care providers.

Generally, telehealth visits result in a recertification at about the same rate as those done in-person, according to a 2020 study published in the Journal of Pain and Symptom Management. Researchers conducted 88 concurrent in-person and telehealth visits between June and November 2019. They also found that 88% of patients and caregivers and 78% of providers for telehealth to be as effective as in-person visits.

A range of stakeholders in the hospice space have voiced support for the legislation.

“[Telehealth] is just one more tool in the toolbox to allow hospices to serve their patients as best as they can. It’s really leaving the decision up to the hospice and the physician or the nurse practitioner,” Logan Hoover, vice president of health policy and government relations at the National Hospice and Palliative Care Organization (NHPCO), told Hospice News. “It isn’t that we think that virtual is better than in-person, we just think that the hospice or the physician or the nurse practitioner should have the option to choose what is going to be in the best interests of our patients, for any given scenario.”

In a letter sent to Ways & Means chair and ranking members this afternoon, NHPCO also indicated that allowing telehealth recertifications would be cost neutral, because those encounters are included in the hospice per diem.

Ensuring access to telehealth is a “realistic response” to providers and consumers needs, according to Katie Smith-Sloan, president and CEO of LeadingAge, an association of more than 5,400 nonprofit senior care providers.

“Telehealth is the new normal approach for delivering so much of care today,” Smith-Sloan said in a statement. “From the authorization of audio-only communications platforms to continuation of flexibilities for Medicare providers and recipients regarding mental health services and origination sites, this bill, if enacted, would bring efficiency and greater access for older adults in need of care and supports.”