Government Shutdown Likely to Impact Home Health and Hospice
(Oct. 7, 2025) Please see the following information from LeadingAge National on the potential impacts of the government shutdown on telehealth and Hospital at Home for home health, and the face-to-face certification and Internet Quality Improvement and Evaluation System (iQIES) support for hospice providers. Other impacts are included as well.
Home Health Agencies
At this time, LeadingAge National does not believe that Congress will come to an agreement on a Continuing Resolution (CR) by midnight on Sept. 30th. This has a number of consequences for home health agencies.
For home health, if the government shuts down, the telehealth flexibilities for a face-to-face encounter will expire tonight, and we will revert back to pre-pandemic in-person face-to-face expectations. LeadingAge National is not expecting any guidance from the Centers for Medicare and Medicaid Services (CMS); they have been clear that an expiration of the congressionally authorized flexibilities means a reversion back to pre-March 2020 rules. They have no authority for leniency.
This is going to limit home health access for patients who have not seen their referring clinician in the last 90 days and live in rural areas or lack access to transportation to get to a clinician. Home health agencies should be reaching out to their patients who are likely to need additional episodes and make sure that they have a plan to see their referring provider in person.
There will also be other implications for telehealth for Part B billing of telehealth services:
- The home can no longer be an originating site and must instead be a facility location like a hospital, skilled nursing facility (SNF), physician office, etc.
- Geographic restrictions will go back into place, meaning the originating site must be located in a certain geographic location. This means that the site for telehealth must be in a rural Health Professional Shortage Area (HPSA), located in a county that is not included in a Metropolitan Statistical Area (MSA), or within a federal telehealth demonstration project. You can check your geographic area here.
- Two-way, interactive, audio-video technology will now be required for telehealth.
- Limitations on the scope of practitioners who can provide telehealth services, specifically excluding occupational therapists (OTs), physical therapists (PTs), speech-language pathologists (SLPs), and audiologists. If you provide Part B outpatient therapy as a line of business, this will impact your ability to perform this service via telehealth.
This lapse in a CR will also impact the Hospital at Home program, which is set to expire Sept. 30th. If you are supporting a Hospital at Home program, those will cease to operate Sept. 30th. Without the waiver extension, patients will cease to receive care under the programs and need to return to hospitals. While these programs are typically small, with 10-40 patients, this could stress local hospital capacities. Anyone who has one of those programs needs to be reaching out to their hospital partners now and coordinating for potential admissions and talking to patients and families about what this means for their ongoing care.
Prescribing of controlled substance via telehealth will not be impacted, as it was a separate proposed rule issued by the Drug Enforcement Agency (DEA). If the agency does not act to extend the current flexibility or finalize the proposed rule issued in January 2025, these flexibilities will end Dec. 31, 2025.
Hospice
For hospices, if the government shuts down, the face-to-face telehealth flexibility will expire tonight, and we will revert back to pre-pandemic in-person face-to-face expectations. As with home health, LeadingAge National is not expecting any guidance from CMS; they have been clear that an expiration of the congressionally authorized flexibilities means a reversion back to pre-March 2020 rules. They have no authority for leniency.
As a reminder, per 418.22(4)(i): "The face-to-face encounter must occur prior to, but no more than 30 calendar days prior to, the 3rd benefit period recertification, and every benefit period recertification thereafter." As of Oct. 1st, you will need to conduct face-to-face visits in person. It is likely that when Congress does pass a CR, they will allow retroactive telehealth payments; however, that will not waive the regulatory requirements for timely face-to-face visits. It is not clear how long a shutdown will last, so LeadingAge National recommends having a plan to conduct visits in person for all face-to-face recertifications starting Oct. 1st.
Additionally, for hospices, LeadingAge National does not anticipate iQIES Help Desk staff to be qualified as essential employees, so you may see increased wait times for support, which is complicated timing given the Hospice Outcomes and Patient Evaluation (HOPE) tool launch date of Oct. 1st. LeadingAge National does not expect CMS to delay HOPE implementation in response to a shutdown.
For palliative care providers, there will also be implications for Part B billing of telehealth services:
- The home can no longer be an originating site and must instead be a facility location like a hospital, SNF, physician office, etc.
- Geographic restrictions will go back into place, meaning the originating site must be located in a certain geographic location. This means that the site for telehealth must be in a rural HPSA, located in a county that is not included in an MSA, or within a federal telehealth demonstration project. You can check your geographic area here.
- Two-way, interactive, audio-video technology will be required for telehealth.
- Limitations on the scope of practitioners who can provide telehealth services, specifically excluding OTs, PTs, SLPs, and audiologists.
Prescribing of controlled substance via telehealth will not be impacted, as it was a separate proposed rule issued by the DEA. If the agency does not act to extend the current flexibility or finalize the proposed rule issued in January 2025, these flexibilities will end Dec. 31, 2025.
Provider members are encouraged to track the lack of access for patients as we move through the shutdown, so that LeadingAge National can share with CMS and Congress how this impacts both patients and providers moving forward.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871