Telehealth Flexibilities for Medicare Patients Extended – Future Uncertain, Urgency Persists
On December 20, 2024, Congress passed a short-term spending bill for the purpose of keeping the federal government operational through mid-March 2025. Our primary focus in working with our US House and US Senate members leading up to and during the bill’s debate was the inclusion of Medicare payment fix for physicians. From introduction to enactment, the bill was edited and the Medicare payment provision was ultimately eliminated. There was, however, an important measure that survived the bill edits – a temporary extension of Medicare telehealth coverage.
Section 3027 of the enacted federal funding legislation, H.R. 10545 / American Relief Act, entitled Extension of Certain Telehealth Flexibilities, keeps telehealth considerations under Medicare in place through March 31, 2025. Among those provisions are the following:
1. Audio-only services
2. Geographic and originating site requirements
3. Eligible providers
4. Mental health services
These and other provisions were implemented to maintain access to telehealth services for Medicare patients during the COVID-19 pandemic and public health emergency (PHE). In recognition of the positive impact of the flexibilities implemented, bipartisan health policy discussion on Capitol Hill has acknowledged the value of telehealth and has addressed continued support of the enacted flexibilities.
In March 2024 stand-alone bills that Congress considered last year – H.R. 7623 / S.3967 – Telehealth Modernization Act of 2024. This legislation proposed extending the telehealth coverages through 2026. These extensions follow what was included in the year-end funding package. North Carolina’s House and Senate members who signed on as co-sponsors of these bills included Congresswoman Deborah Ross, Congressman Wiley Nickel and Senator Thom Tillis. Comparable legislation is anticipated in 2025.
What hangs in the balance?
The Medicare telehealth flexibilities currently in place are scheduled to expire on March 31, 2025, if Congress enacts another extension or acts to make them permanent. The initial word from Capitol Hill is encouraging with regard to support of further extensions but there is uncertainty of the focus of cost-cutting targets under the new administration. A failure to extend the flexibilities will have an impact on physicians and other providers as well as patients. Notable flexibilities include:
Telehealth Delivery
Telehealth flexibilities currently allow for patient encounters via audio-only. Prior to the pandemic such engagement with required the use of two-way audio/video technology. An expiration of the Medicare telehealth flexibilities would eliminate the audio-only option.
Geographic/site of care requirements
As a result of the pandemic and the declaration of a public health emergency (PHE), flexibilities were extended to allow Medicare patients to receive care via telehealth at “any site in the United States at which the eligible telehealth individual is located at the time the service is furnished… including the home of an individual.” Eliminating this flexibility would result in an access to care issue for some patients, especially those in rural and underserved areas.
Providers eligible to provide telehealth services
Under the flexibilities extended as a result of the pandemic PHE, Medicare patients were allowed to access care via telehealth from an expanded list of providers, such physical therapists, occupational therapists, etc. If the flexibilities are not extended, the eligibility to provide telehealth services will revert to pre-pandemic rules and a more restricted list of approved providers, which would limit access to care.
Behavioral Health
Under the telehealth flexibilities Medicare patients receiving behavioral health care are eligible to obtain those services via telehealth with no in-person visit requirements. If the flexibilities expire, Medicare beneficiaries receiving mental health services via telehealth will be required to have at least one in-person visit every 12 months.
The outlook for 2025 is that an extension of coverage for Medicare telehealth services will be part of the discussion when Congress again engages in debate over funding of the federal government. Such action will be necessary early in the year since the current funding package expires in March. The reintroduction of standalone bills is anticipated as well.