When the government shut down at midnight on September 30, telehealth extensions that Medicare providers have relied on for the past five years also expired. During the COVID-19 public health emergency, Congress allowed non-enforcement of several restrictive telehealth statutes, and CMS waived these regulations. Each year since, Congress has temporarily extended these waivers through the appropriations process. Despite ongoing advocacy for a permanent fix, Congress has not acted, leaving Medicare providers and beneficiaries at risk of losing these flexibilities.
Medicare providers now face a dilemma: suspend telehealth services until Congress renews the extensions, or continue offering them and billing Medicare without assurance of payment. Some are leaning toward the latter, hoping Congress will retroactively reinstate telehealth coverage. If a funding bill extends these flexibilities effective October 1, 2025, providers who continued offering telehealth during the shutdown could still be reimbursed.
On October 1, CMS and the Medicare Administrative Contractors advised providers furnishing telehealth services not currently covered by Medicare to have beneficiaries sign an Advance Beneficiary Notice of Noncoverage. This notice alerts patients that they may be responsible for the cost if Medicare does not pay for the service.
Two statutory requirements are now back in place until Congress takes further action:
- Geographic requirement: Telehealth coverage is once again limited to patients in certain rural areas, as it was before the pandemic.
- Originating site requirement: Telehealth visits must occur at an approved medical facility, meaning patients generally cannot receive telehealth from home.
Without statutory extensions, geographic restrictions are once again in effect; audio-only visits are prohibited (except in limited cases); some non-physician practitioners can no longer provide telehealth services; and the Acute Hospital Care at Home initiative is no longer in effect.
There are concerns that this pullback could have ripple effects beyond Medicare. If the lapse continues, commercial insurers may also scale back telehealth coverage, further limiting access to virtual care.
Applied Policy is supporting clients in mitigating the impact of the current uncertainty.
Read our previous coverage of telehealth here, here, and here.
