Issue date: February 5th 2026

This week we have following sections covered under this newsletter.

• AMITY HEALTHCARE GROUP NEWS
• NATIONAL NEWS
  • Status of Telehealth Flexibilities
  • CMS Enrollment Site Visits – Contractor Update
  • Office of Management and Budget (OMB) Orders Review of Federal Funding to 14 States
  • CMS Launches Online Provider Complaint Form for Medicare Advantage Plans
  • AGILE Conference | May 4–6, 2026 | Dallas, TX
• COLORADO NEWS
  • PAR Authorization Request Changes (Effective January 2026)
  • Long-Term Home Health & Private Duty Nursing News
• TEXAS NEWS
  • Texas OIG Reporting
  • Provider Revalidation Update

AMITY HEALTHCARE GROUP NEWS

Amity Healthcare Group is excited to announce that we are a proud sponsor of the ACHCU Academy Education Event for Health Care!

We’re glad to support ACHCU Academy and look forward to connecting with you on Amelia Island, Florida. Be sure to stop by Booth #18 at the expo – we’d love to say hello!

ACHCU Academy

March 2 – 4, 2026

Amelia Island, Florida

If you missed our recent webinar, Mastering the Documentation of Reasonable and Necessary Care in Home Health, hosted by Amity Healthcare Gorup and ACHCU, you can still watch or download the presentation.

NATIONAL NEW

Status of Telehealth Flexibilities

On February 3, 2026, the U.S. House of Representatives approved a legislative package to reopen the federal government and extend several important health care flexibilities that originated during the COVID‑19 pandemic.

As a result, Federal telehealth flexibilities have been extended through December 31, 2027. Specifically, for home health agencies, it extends provisions removing geographic requirements and expanding originating sites through December 31, 2027. This allows the required face-to-face visit (F2F) to be performed via telehealth

CMS Enrollment Site Visits – Contractor Update

As you know, the Centers for Medicare and Medicaid Services (CMS) conducts enrollment site visits associated with a provider’s initial CMS-855A application, upon revalidation, change in location or anytime in between.

These visits are conducted to confirm the provider’s or supplier’s operational status and compliance with enrollment requirements.

On January 3, 2026, CMS announced new site verification contractors as follows:

1. East-Arch Systems, LLC
   Arch Systems is now responsible for site visits in the Eastern U.S. under the CMS Provider Enrollment program.
   Contact info:
   • Phone: (301) 683-2132
   • Address: 1800 Washington Blvd, Ste 421, Baltimore, MD 21230-1735
   • Website: http://www.archsystemsinc.com
   • General Email: vehsan@archsystemsinc.com
     
     
2. West-Signature Consulting Group, LLC
   Signature Consulting Group will conduct site visits in the Western U.S. under the CMS Provider Enrollment program.
   Contact info:
   • Phone: (410) 277-3440
   • Address: 7108 Ambassador Rd., Suite 150, Windsor Mill, MD 21244
   • Website: http://www.sghealthit.com
   • Email: contracts@sghealthit.com

Outgoing Contractors (through February 14, 2026):

1. East: Palmetto GBA and its subcontractors
   Providers should contact Palmetto GBA via their MAC for enrollment/site-visit verification assistance. The number below is for- Jurisdiction M Home Health and Hospice MAC.
   Palmetto GBA Provider Contact Center: 855-696-0705
2. West: Deloitte Consulting LLP and its subcontractors
   There is no central public contact for Deloitte’s site-visit group; providers should verify a visit with their MAC.

Please remember that ALL of the CMS-initiated site visits are unannounced and the inspectors performing these visits, per CMS, should be carrying an ID and a CMS-issued letter of authorization, which the provider being visited may review but not retain or copy. If a site visitor does not provide this information, please confirm contractor identity by requesting the visitor’s ID and CMS-issued letter of authorization as well as contacting the applicable site verification contractor, if necessary.

Office of Management and Budget (OMB) Orders Review of Federal Funding to 14 States

On January 20, the Office of Management and Budget (OMB) sent a memorandum to Federal agencies regarding a review of Federal funding provided to entities within 14 defined states.

As reported by Real Clear Politics and Politico, the 14 states included in the directive are:

• California
• Colorado
• Connecticut
• Delaware
• Illinois
• Minnesota
• New Jersey
• New York
• Massachusetts
• Oregon
• Rhode Island
• Vermont
• Virginia
• Washington State
• Washington, D.C.

Home care services, including Medicaid, the Social Services Block Grant, Older Americans Act funding, workforce development funding, and a wide range of other Federal funds would be impacted by the directive. According to the memo, “this information will be used to better understand the scope of funding in certain States and localities in order to facilitate efforts to reduce the improper and fraudulent use of those funds through administrative means or legislative proposals to Congress.”

This memo reflects a potential risk of intensive auditing and program integrity oversight of a wide range of funding.

Home health and home care agencies are encouraged to review and update their compliance plans, re-educate staff on compliance and fraud, waste, and abuse expectations, conduct internal reviews, and confirm that services are being provided in accordance with program requirements. Multiple states also encourage self-reporting of any identified issues.

CMS Launches Online Provider Complaint Form for Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) has introduced a new web-based provider complaints form designed to report concerns related to Medicare Advantage (MA) plans. As outlined in recent CMS memo, this form is intended to streamline how provider complaints are submitted and processed within CMS.

Using this updated process, providers may submit complaints about MA plans directly through the online portal. Submitted complaints are automatically entered into CMS’s Health Plan Management System (HPMS) within the Complaints Tracking Module (CTM). CMS will conduct an initial review of each submission and assign the applicable contract number before any further action is taken. This represents a shift from the prior approach, as CMS now performs the preliminary review instead of sending complaints directly to the health plans.

The online submission form requests the following information:

• Complainant contact and identifying details
• Beneficiary information
• Provider information
• The Medicare Advantage plan in question
• A written description of the complaint
• Claim number and date(s) of service (if available)

The Provider Complaints Form can be accessed here

ABN Form

As you may know, the current CMS ABN form has a January 31, 2026, expiration date. The next revision of the form remains under review as part of the Paperwork Reduction Act (PRA) process. Meanwhile, providers may continue using the existing ABN form, even after the expiration date, until CMS publishes a revised version.

CMS has stated: “In the event the notice expires, providers and plans may continue using the current version of the notice after the expiration date. Once the OMB control number for this notice is reauthorized, CMS will notify the industry and update CMS.gov accordingly. Providers and plans will have 60 calendar days from the date of the CMS notification to begin using the updated notice.”

Industry Events/Educational Opportunities:

New and Updated Resources Available for the Expanded HHVBP Model

On January 21, 2026, the Centers for Medicare & Medicaid Services (CMS) announced that new and updated resources are now available on the Expanded Home Health Value-Based Purchasing (HHVBP) Model Webpage.

New Resources

• Expanded HHVBP Model Web-Based Training: Changes to the Applicable Measure Set Beginning in CY 2026
  • Written Resource (PDF)

Updated Resources:

• HHVBP Model Guide (PDF)
• FAQs (PDF)
• Newsletter (PDF)

CMS has also posted results from the second performance year of the expanded HHVBP Model (CY 2024) in the Provider Data Catalog (PDC).

AGILE Conference | May 4–6, 2026 | Dallas, TX

The AGILE conference is coming to Dallas on May 4 – 6, 2026. The conference offers industry insights, leadership perspectives, access to innovative solutions, and up to 20 hours of clinical CEUs – all focused on shaping the future of care at home.

Take advantage of an Early Bird pricing that has been extended through February 15, 2026. REGISTER NOW

COLORADO NEWS

PAR Authorization Request Changes (Effective January 2026)

While this topic was discussed in our prior newsletter, additional update to LTHH PAR processing have been added in the most recent Medicaid Provider Bulletin. The new change is highlighted below for your review.

Beginning January 2026, the following updates will apply to Pend and Prior Authorization.

• Standard PAR request shall be completed within seven (7) calendar days.
• Expedited PARs must be completed within 72 hours.
• PARs submitted as Expedited: No Pends or requests for information will be allowed in compliance with the rule requirement for three (3) calendar days.
• A Pend Authorization Request for additional information will be reduced from 10 business days to seven (7) calendar days.
• Additional Pends on the same PAR will not be extended. All information requested in the initial Pend must be supplied or the PAR will result in a technical denial.

Prior Authorization Request (PAR) submission requirements for Certified Nurse Aide (CNA):

• Per 10 CCR 2505-10 8.500, home health agencies are responsible for submitting detailed orders on a Plan of Care (POC).
• The Home Health Agency shall indicate a comprehensive list of the amount, frequency and expected duration of provider visits for each discipline ordered by the Member’s Physician or Allowed Practitioner, including orders for CNA services.
• This shall include the specific duties, treatments and tasks to be performed during each visit, including CNA visits.
• Failure to provide the appropriate level of specificity in the Plan of Care or supporting documentation may result in more pends and adverse determinations.

Long-Term Home Health & Private Duty Nursing News

I) Continuation of Benefits (COB) Clarification for Pediatric LTHH CNA Services

HCPF is issuing a reminder on how Continuation of Benefits (COB) applies to pediatric LTHH CNA services following the reinstatement of prior authorization (PAR) requirements. In limited circumstances, members who were receiving services immediately before a PAR submission and who submit a timely appeal may be eligible for COB, even if a PAR did not previously exist due to Public Health Emergency flexibilities. COB does not apply to reconsiderations, peer-to-peer reviews, or situations in which services were not in place prior to PAR submission. When COB is not available, transition protections may still be applicable to support continuity of care. Providers and families are encouraged to carefully review denial notices and comply with the appeal timelines outlined in rule.

II) PDN Authorized Hours and Scheduling Reminder

HCPF is reminding providers that Private Duty Nursing (PDN) hours approved through the prior authorization process must be delivered exactly as authorized and in alignment with the member’s plan of care. Approved PDN hours are based on medical necessity, including the specified timing of services, and may not be reassigned to different times of day for staffing or operational convenience. Any modifications to the timing or use of authorized PDN hours require updated medical justification and prior approval to ensure services continue to meet the member’s clinical needs.

III) HCPF Home Health and PDN Questions & Answers

Q: Does HCPF allow one nurse to provide PDN services to more than one member at the same time?

A: “Sometimes – but not by default. HCPF does not approve “group nursing” automatically or use fixed nurse-to-member ratios. When one nurse serves multiple members, agencies must demonstrate case by case that care remains home- or community-based, member-specific, and safe. This includes showing that each member’s acuity, stability, and skilled nursing needs can be met simultaneously without risk. Experience alone or living in the same home is not sufficient; approval depends on an acuity-based justification and clear documentation of how all members’ PDN needs will be safely addressed.”

Q: Can a nurse provide PDN services for two different agencies or exceed 16 hours in a single day if caring for multiple members at the same time?

A: “No. A nurse may not simultaneously work for two agencies during the same hours while providing PDN to different members, even if those members are in the same setting. In addition, nurses must comply with the 16-hours-per-day limit. PDN hours are counted based on the nurse’s time worked, not per member, and overlapping shifts across agencies or assignments that exceed daily limits are not permitted.”

Q: When a member receives Home and Community-Based Services (HCBS) or Community First Choice (CFC) services, should Home Health Agencies share the 485/Plan of Care (POC) with the Case Management Agency (CMA)?

A: “Yes. When a member receives HCBS or CFC services, providers should share the 485/POC with the member’s CMA in order to meet the care coordination requirements as outlined in Informational Memo IM 25-009 and 10 CCR 2505-10-8.520.”

Q: With the Nurse Assessor Program being canceled, shall the home health providers resume utilization of PAT and PDN acuity tool for the PLTHH and PDN service assessments?

A: “Given the very recent changes related to the Nurse Assessor Program ending, HCPF is still finalizing guidance to best support agencies during this transition period. As soon as communication is finalized, we will be sharing it publicly with providers and stakeholders. Additional information and clarification will be forthcoming.”

TEXAS NEWS

Texas OIG Reporting

The Texas Office of Inspector General (OIG) has implemented a new online reporting system designed to gather and direct case information to the appropriate OIG intake unit. This portal is intended solely for reporting suspected fraud, waste, and abuse and may involve individuals, providers, contractors, retailers, state employees, or other related parties.

Suspected violations may be reported by calling the OIG Fraud Hotline at 1-800-436-6184 or by submitting a report through the online system.

To access the new OIG Online Reporting System (ORS) for fraud reporting, please visit THIS LINK

Provider Revalidation Update

TMHP and HHSC have released an important update regarding the criteria for providers to receive additional revalidation due date extensions. Starting February 1, 2026, providers must have a revalidation application already submitted and in progress to receive a second or third extension.

Providers are being advised that they must begin the revalidation process as soon as possible-up to 180 days before the revalidation due date. This helps prevent enrollment interruptions.

An “in‑flight” application is one that has been completed and submitted in PEMS and is not yet approved (please note that applications saved in draft status do not count as “in‑flight”).

Below are the new extension eligibility rules effective February 1, 2026:

1. First Extension – Providers who have not received a prior extension and have a revalidation due date on or before May 31, 2026, are eligible for a one‑time 180‑day extension.
2. Second Extension – Providers may receive a second 180‑day extension only if their current due date is on or before May 31, 2026 (after receiving the first extension), and a revalidation application was submitted in PEMS before the due date.
3. Third Extension – Providers may receive a third extension of 60 days only if their current due date is on or before May 31, 2026 (after receiving two 180‑day extensions), and a revalidation application was submitted in PEMS before the due date.

Extensions are applied when PEMS checks revalidation due dates daily. If a provider is due for revalidation the next day, has not yet completed the revalidation process, and meets the extension requirements, PEMS will automatically apply the extension. The new due date will appear in the Revalidation Due Dates column on the Provider Information page in PEMS and you will receive an email notification as well.

Please review the entire notice for additional details and resource information.