News

We are now three months removed from the uncertainty surrounding Congress’ renewal of certain key flexibilities in Medicare reimbursement for telehealth. Not much has changed over that time. In a continuing resolution passed at the end of last year, Congress temporarily extended several of the most critical telehealth reimbursement provisions adopted during the COVID-19 Public Health Emergency for three months, until March 31, 2025[1]:

• Originating Site Requirements—Waiver of the geographic restrictions on the “originating site” for non-behavioral health telehealth services, such as allowing reimbursement for telehealth services delivered in a patient’s home;
• Practitioners —Expanded telehealth reimbursement to additional provider types;
• In-person Evaluation — Waiver of the requirement to conduct an in-person visit within six months of an initial telehealth encounter for behavioral health patients; and
• Audio only — Expanded reimbursement for audio-only telehealth services.

Once again facing a deadline imposed by the expiring continuing resolution, Congress is seeking to maintain the status quo when it comes to telehealth reimbursement policy. In an updated continuing resolution announced on March 8, intended to fund the government thru the end of September, Congress also proposed extending these same telehealth flexibilities thru September 30, 2025[2].

As a reminder, the end of these flexibilities may result in a dramatic reduction in the scope of Medicare Fee-For-Service reimbursement for telehealth that providers and patients alike have grown accustomed to, including:

• Reverting to the pre-pandemic restriction that Medicare Fee-For-Service may only reimburse telehealth services the provider delivers those services to a patient located at an approved “originating site,” such as a hospital or clinic. This includes removal of Medicare Fee-For-Service reimbursement for almost all telehealth services delivered to a patient in their home.
• Limitation of the types of telehealth services eligible for reimbursement from Medicare Fee-For-Service.
• Significant reduction in reimbursement for audio-only telehealth services.
• Return to limits on the types of providers that are eligible for reimbursement for providing telehealth services, with specialties such as occupational therapy, physical therapy, and speech-language pathology becoming ineligible (unless an “eligible provider” bills for those services using the incident to billing rules).
• A return of the requirement that behavioral-health providers must conduct an in-person visit with telehealth patients within 6 months of an initial telehealth encounter, with subsequent in-person visits following every 12 months.

If the waivers expire, commercial payors, including Medicare Advantage plans, as well as state Medicaid programs could continue to offer reimbursement for telehealth services beyond what Medicare fee-for-service covers. However, those payors may ultimately modify their reimbursement policies in response to the flexibilities expiring. Providers may also continue to offer non-covered telehealth services to Medicare Fee-For-Service beneficiaries on a cash-pay basis, though any provider offering this opportunity would need to comply with Medicare notice and eligibility requirements as well as state law.

There is little news on the fate of many of the other flexibilities that Congress did allow to expire at the end of last year, including the status of telehealth as an excepted benefit, expansion of the Medicare Diabetes Prevention Program to include telehealth components and expanded Medicare coverage for in-home cardiopulmonary rehabilitation services. One positive development was the announced[3] re-introduction of the Telehealth Expansion Act, which would renew and permanently extend first dollar telehealth coverage in high-deductible health plans. Whether this particular piece of legislation will finally get its chance in the spotlight, after having been introduced in each of the last four congressional sessions, or first dollar HDHP coverage will make it into some other larger bill, it is hopefully an indication of the continued bi-partisan support for telehealth policy certainty.

Continue to follow our updates on the progress of the CR and other telehealth-related legislation to track its impact on patients and providers. If you have questions, please contact our team.