Government Shut Down Ends with President Trump Signing the Consolidated Appropriations Act of 2026
On February 3, 2026, Congress approved and President Trump signed the Consolidated Appropriations Act of 2026, officially ending the federal government shutdown. The legislation includes a Continuing Resolution (CR) that funds most federal operations through September 30, 2026. In addition to maintaining government operations, the bill contains several provisions relevant to care-at-home providers, including extensions of telehealth flexibilities.
Telehealth flexibilities are extended through December 31, 2027. However, new limitations affect the use of telehealth for required face-to-face encounters for certain hospice providers. CMS has indicated that additional time is needed to determine how these requirements will be implemented. The Agency has stated it intends to provide advance notice prior to implementing new telehealth guardrails. Additional guidance is expected as implementation details are finalized.
Sec 6101: Streamlined enrollment process for eligible out-of-state providers under Medicaid and CHIP:
This provision requires states to establish an expedited enrollment process for providers serving Medicaid or CHIP beneficiaries under age 21 in a state other than where the provider is primarily enrolled. To qualify for this streamlined enrollment, providers must be caring for individuals under age 21, be designated as “limited risk” by CMS, HHS, or their home-state Medicaid agency, and not be subject to any federal or state program exclusions.
It is unclear whether home care providers would qualify under this provision. CMS classifies home health and hospice agencies as “moderate risk,” and states may not assign a lower risk designation than CMS. Personal care agencies, private duty nursing providers, and other non-Medicare home care providers are also frequently categorized as moderate or high risk under state Medicaid programs.
Sec. 6102. Removing certain age restrictions on Medicaid eligibility for working adults with disabilities:
This section modifies the Medicaid Buy-In program for working adults with disabilities by eliminating the upper age limit, allowing individuals over age 65 to qualify for coverage.
Sec 6103: Medicaid State plan requirement for determining residency and coverage for military families:
Beginning in 2030, states will be required to maintain Medicaid eligibility for service members and their family members who relocate out of state due to military orders while receiving home- and community-based services (HCBS). Individuals on HCBS waiver waiting lists must retain their position on those lists following relocation. The Department of Health and Human Services is directed to issue guidance on how coverage should be transitioned to the new state.
Sec 6207: Extension of funding for Medicare hospice surveys:
The legislation appropriates an additional $4.4 million for Medicare hospice surveys through the end of the current calendar year, with funds remaining available until expended. This extends funding originally authorized under the IMPACT Act of 2014, which expired at the end of fiscal year 2025.
Sec 6209: Extension of Certain Telehealth Flexibilities:
For home health agencies, the Act extends the removal of geographic restrictions and the expansion of allowable originating sites for telehealth services through December 31, 2027. This continuation permits required face-to-face encounters to be conducted via telehealth.
For hospice providers, telehealth flexibilities for face-to-face encounters are also extended through December 31, 2027, with new limitations beginning January 31, 2026.
Telehealth may not be used if:
The hospice patient is located in an area subject to a CMS hospice enrollment moratorium;
The hospice provider is under a Provisional Period of Enhanced Oversight (PPEO); or
The encounter is conducted by a hospice physician or nurse practitioner who is not enrolled in Medicare and is not an opt-out practitioner.
CMS is also required to establish a claims modifier or code to indicate when a hospice face-to-face encounter is conducted via telehealth, effective January 1, 2027.
Sec 6218: Extension of adjustment to calculation of hospice cap amount under Medicare:
This provision extends changes to the hospice cap calculation originally established under the IMPACT Act of 2014. For calendar years 2034 and 2035, the hospice cap will be updated using the annual payment update percentage rather than the Consumer Price Index for Urban Consumers (CPI-U). This adjustment is expected to reduce the annual increase of the hospice cap amount.
