On February 3, President Trump signed into law an appropriations “minibus” package that funds the Department of Health and Human Services (HHS) for fiscal year (FY) 2026 and extends several health care programs, including Medicare telehealth flexibilities.

Points of interest

• GPCI Floor: Extends Medicare 1.0 Work GPCI floor through January 1, 2027.
• Telehealth: Extends temporary Medicare telehealth coverage flexibilities (effective during COVID) through December 31, 2027.
  • The bill aims to maintain expanded access to virtual care for Medicare beneficiaries while Congress works on longer‑term telehealth reforms.
  • By January 1, 2027, the bill requires CMS to implement new codes or modifiers to document when a telehealth service is furnished through a virtual platform by a physician or practitioner that contracts with an entity that owns the virtual platform or for which the physician or practitioner has a payment arrangement with an entity for use of the platform.

• Within one year of the bill’s enactment, HHS will be required to develop and issue guidance on furnishing telehealth to individuals with limited English proficiency.
• Beginning with the 2028 plan year (and subsequent years), all Medicare Advantage plans will be required to maintain a publicly available and accurate provider directory on their websites.
  1. If a beneficiary receives care from a provider who is listed as in-network, but who is not participating, the beneficiary’s cost sharing will be the lesser of either the cost sharing amount had it been in-network or the out-of-network cost sharing amount. MA plans will notify all enrollees about these protections.
• Beginning January 1, 2029, CMS must begin using DME prepayment reviews for DMEPOS claims by providers billing for DMEPOS products included on the CMS Master List of items potentially subject to prior authorization and other requirements if the provider is
  1. furnishing the item or service to an individual for the first time within a period to be defined by CMS (but not less than 24 months) and,
  2. if that item or service is not already subject to prior authorization.

• Beginning January 1, 2028, all off-campus hospital outpatient departments (OPDs) must begin using a unique NPI on claims.
  • HHS OIG will issue a report analyzing this policy by January 1, 2030.
• The bill extends the 2% Medicare Sequestration reduction through February 2033.
• States will be required to allow out-of-state providers to enroll in their state’s Medicaid program without imposing requirements beyond the minimum necessary for the state. The enrollments will be for five years.

Michele Krpata, BSW, CPC, CPMA

Compliance Officer, Quality Reporting Analyst

Integrated Physicians Management Services