Will Congress Save Telehealth?

Pandemic-era telehealth waivers that allowed providers to expand their virtual care footprint will end this year unless Congress takes action.

The Centers for Medicare & Medicaid Services (CMS) announced in its finalized 2025 Physician Fee Schedule that it won’t extend most of those waivers any longer, putting back in place pre-COVID telehealth limitations. Those include restrictions on where telehealth can be provided and delivered, as well as who can use telehealth through Medicare.

The end of the waivers would curtail a number of telehealth strategies, especially for older Americans and those living in urban and suburban areas. It would also limit the use of virtual care by specialists and other types of care providers (such as physical and occupational therapists and speech language pathologists) and limit where telehealth can be provided to certain CMS-approved sites, like health clinics.

CMS has, however, included some changes in telehealth regulation for the coming year, including a one-year extension of the waiver allowing providers who bill Medicare for their services and deliver virtual care from their homes to list their practice as the site of telehealth delivery.

“Allowing appropriately licensed and credentialed providers to practice telehealth from their home improves patient access to healthcare services, reduces healthcare costs, while maintaining and meeting patient demand for care,” advocates said in an October letter to CMS Administrator Chiquita Brooks-LaSure. “This was necessary during the height of the COVID-19 pandemic and remains just as important today amidst provider workforce shortages and burnout, given that 78 percent of health care practitioners agree that retaining the opinion to provide virtual care from a location convenient to the practitioner would ‘significantly reduce the challenges of stress, burnout, or fatigue’ facing their profession and eight in 10 indicate that this flexibility would make them more likely to continue providing medical care.”

In addition, CMS is:

• Finalizing a proposal to add several services to the Medicare Telehealth Services List, including caregiver training services on a professional basis and PrEP counseling and safety interventions on a permanent basis. For CY 2025, the agency will continue to suspend limits on the frequency of subsequent inpatient and nursing facility visits and critical care consultations.
• Making permanent a ruling that Medicare telehealth services delivered to patients in their home can be done by two-way, real-time, audio-only communication technology (such as a phone) if the patient doesn’t have or want access to video services and the provider can offer that platform.
• Making permanent a new definition of “direct supervision” for certain services that are required to furnish under the direct supervision of a physician or other supervising practitioner. The new definition would allow the supervising physician or practitioner to use real-time, interactive, audio-visual communications. For all other services, CMS is extending the use of supervision by telemedicine for one year.
• Extending for one year a policy to allow teaching physicians to use telemedicine for purposes of billing for services furnished involving residents in all teaching settings, but only in clinical instances when the service is furnished virtually (such as in a three-way telehealth visit involving the patient, resident and teaching physician).

Led by the ATA, telehealth advocates are holding out hope that Congress will take action on one or more of several bills currently before lawmakers. They include:

• The Bipartisan Telehealth Modernization Act of 2024 (R. 7623 and S. 3967) and the CONNECT for Health Act (H.R. 4189 and S. 2016), which would extend Medicare telehealth flexibilities through 2026.
• The Telehealth Expansion Act (1001, HR 1843), which would permanently allow individuals with HDHP-HSAs to access telehealth services before meeting their deductible.
• The Medicare Telehealth Privacy Act of 2023 (HR 6364), which would make permanent the provision allowing providers to bill for telehealth services using their practice address rather than their home address.
• The Telehealth Benefit Expansion for Workers Act of 2023 (HR 824), which would permanently classify telehealth as an excepted benefit, enhancing access for workers.