Skip to main content
  • Jun 12, 2025

    CMS Clarifies Telehealth & RPM Guidance... Plus, Continuation of the FCHIP Demonstration

    CCHP
    CMS Releases Updated Telehealth and RPM MLN Booklet
    In late April, the Centers for Medicare and Medicaid Services updated its Medicare Learning Network (MLN) Telehealth and Patient Monitoring Booklet to reflect recent policy changes made in compliance with H.R. 1968—the Continuing Resolution, which passed in March, and extends many Medicare telehealth flexibilities through September 30, 2025. CCHP covered these extensions in a previous newsletter, including highlighting the need for CMS to update their telehealth materials in light of the Medicare extensions.  Substantive updates in the updated booklet are marked in dark red for easy reference.  The updates include: 
    • Audio-Only Telehealth: Continued allowance of audio-only communication for non-behavioral and non-mental health visits through September 30, 2025.
    • Expanded Provider Eligibility: A broader range of Medicare-enrolled providers remain eligible to deliver telehealth services through September 30, 2025.
    • Hospice Recertification: Providers may use telehealth to recertify hospice care eligibility through September 30, 2025.
    • In-Person Visit Delays: Waived in-person visit requirements for behavioral and mental health services remain in place through September 30, 2025.
    • FQHCs & RHCs: Federally Qualified Health Centers and Rural Health Clinics may continue delivering non-behavioral/mental telehealth services through September 30, 2025.  Note that CMS has also noted that FQHCs and RHCs can continue billing for non-behavioral health telehealth services using G2025 through Dec. 31, 2025, as reflected in the FQHC/RHC Chapter of the Medicare Benefit Policy Manual.
    • Hospital at Home: The Acute Hospital Care at Home Program continues to operate under extended flexibilities through September 30, 2025.
    • CPT code 98016:  This code, defined as a brief synchronous communication technology-based evaluation and management service, was removed from the booklet, with CMS stating that it qualifies as a Communication Technology-Based Service (CTBS), not a Medicare telehealth service.
    Stakeholders are encouraged to review the updated MLN booklet to ensure alignment with current policy and billing requirements.  Note that the majority of the policies outlined above are currently set to expire on September 30, 2025, unless extended by future legislation or regulatory action. CCHP will continue to monitor developments and provide updates on post–September 30 telehealth and RPM policy changes in future newsletters.  See CCHP’s tracking of federal legislation to stay up to date on legislative developments.

    CMS Launches New RPM Webpage to Clarify Coverage and Address Program Integrity Concerns
    The Centers for Medicare and Medicaid Services (CMS) has recently launched a new webpage dedicated to remote patient monitoring (RPM), offering clarifications related to what RPM is, the type of patients (i.e. those with chronic or acute conditions) eligible to receive services, and examples of RPM and billing guidance. This effort follows a September 2024 report from the Office of Inspector General (OIG), which found that 43% of Medicare enrollees receiving RPM did not receive all three required components (see below for an explanation of the components)—raising concerns about whether the benefit is being implemented as intended.

    The new webpage aims to clarify expectations around RPM delivery and reinforce the importance of providing a complete service.  In general, Medicare covers RPM for both chronic and acute conditions as long as the device meets specific US Food and Drug Administration criteria.  The three key components of RPM delivery include:
    1. Education & Setup:  Providers must educate patients on how to use the device and ensure they understand how to transmit data securely and effectively.
    2. Device Supply:  The device must be FDA-approved and capable of collecting and transmitting at least 16 readings every 30 days. Devices include connected blood pressure cuffs, weight scales, and pulse oximeters.  Note that the American Medical Association has altered their requirements as detailed in their September 2024 Panel Actions Summary to remove the 16-day reporting requirement for the RPM device supply code in 2026.  We have yet to see if CMS will adopt this change for 2026 as well.
    3. Treatment & Management:  Providers must review incoming health data and adjust treatment plans accordingly—e.g., changing medications or follow-up scheduling.
    The new webpage clarifies that CMS pays separately for each of the three service components, regardless of device type or the specific physiologic metric collected. Providers may bill using general RPM codes without needing to list an ordering provider on the claim.  CMS emphasizes that missing steps, especially proper education or data collection, may compromise patient care and increase audit risk.
     
    For a broader analysis of RPM utilization trends and policy recommendations, see CCHP’s recent write up of a report conducted by Peterson Healthcare covering RPM utilization numbers and policy recommendations.  To explore CMS’s full guidance, visit the newly released webpage.
    SCOTUS Asked to Review Patent Case with Telehealth Implications

    According to an article published in Law360 [registration required to view], the U.S. Supreme Court is being urged by the owner of Audio Evolution Diagnostics Inc. to hear a case that could reshape how courts evaluate patents tied to digital health and telemedicine.  At issue are the company’s patents for a diagnostic device that records and analyzes bodily sounds—technology that could be used in remote patient monitoring or virtual clinical assessments.  Audio Evolution Diagnostics Inc. is challenging the invalidation of its patents for a diagnostic device that records and analyzes bodily sounds.  The lower courts found the patents to be ineligible under the Alice framework — the Alice Framework is a Supreme Court test that bars patents on abstract ideas unless they contain an “inventive concept” that transforms them into a patent-eligible application. Audio Evolution argues the decision was incorrect.   

    The U.S. Department of Justice has even weighed in, agreeing with Audio Evolution Diagnostics Inc. that the patents should be considered eligible.  In its brief regarding the case (according to Law360), the government reaffirmed that Supreme Court guidance is needed to clarify patent eligibility law but argued this case may not be the right vehicle for broader review. Still, the DOJ acknowledged that technologies—even those built from conventional components—should be patent-eligible if they represent genuine technological innovation. With patent eligibility continuing to pose challenges for telehealth developers, the outcome of this case could carry significant implications.  Read the full article [registration required to view] for more information.
    CMS Proposes Continued Support for Cost-Based Telehealth Payments in Rural Hospitals Under FCHIP Extension

    The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule revising the Medicare hospital inpatient prospective payment systems (IPPS) for fiscal year 2026, with public comments accepted through today (June 10, 2025). Among its provisions, the proposal includes updates related to telehealth, specifically the continued implementation of the five-year extension of the Frontier Community Health Integration Project (FCHIP) Demonstration, authorized under Section 129 of Public Law 116-260. This extension began on January 1, 2022, and is scheduled to run through the end of 2026. The FCHIP Demonstration was designed to increase access to care in rural areas through alternative cost-based reimbursement models for three key service areas: telehealth, ambulance services, and skilled nursing facility/nursing facility services.

    As outlined in the FY 2025 IPPS final rule, as part of the FCHIP Demonstration extension, CMS waived certain Medicare rules for Critical Access Hospitals (CAHs) participating in the extension period. Only the 10 CAHs that took part in the original demonstration were eligible to continue in the extension; five of these CAHs—located in Montana and North Dakota—elected to participate and are currently implementing the interventions. For telehealth, as part of the FCHIP Demonstration, CMS will continue to waive Section 1834(m)(2)(B) of the Social Security Act for FY 2026, which governs the facility fee paid to the originating site. Under the proposed rule, a participating CAH serving as the originating site for a Medicare telehealth service would be reimbursed at 101 percent of its reasonable costs, including overhead, salaries, and fringe benefits associated with delivering telehealth services. However, CMS would not reimburse for the purchase of new telehealth equipment under this provision.

    Additionally, CMS proposes to maintain the waiver of Section 1834(m)(2)(A), which requires that telehealth services furnished by distant site practitioners be reimbursed at the same rate as in-person services under the Medicare Physician Fee Schedule (MPFS). In this demonstration, if a physician or practitioner has reassigned their billing rights to a participating CAH, CMS would reimburse the CAH at 101 percent of reasonable costs for the telehealth services furnished from the CAH as the distant site. This payment structure would apply regardless of whether the CAH uses the Standard or Optional Payment Method II for outpatient services. However, if the physician or practitioner has not reassigned their billing rights to the CAH, reimbursement would follow traditional Medicare fee schedule rules. Aside from these cost-based payment adjustments, CMS does not propose waiving any other provisions of Section 1834(m), including the list of services eligible for Medicare telehealth services.

    Stakeholders are encouraged to review the full proposed rule and submit public comments by June 10, 2025, via the Federal Register. CCHP will continue to monitor the rulemaking process and provide updates as CMS finalizes the FY 2026 IPPS rule later this year.
    Latest Developments in CCHP’s Telehealth Policy Finder

    CCHP’s Telehealth Policy Finder look-up tool and Policy Trend Maps were updated throughout the past month based on the latest information from our ongoing state telehealth policy tracking. The latest states to be updated include California, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Indiana, Maine, New Jersey, Puerto Rico, South Carolina, Virgin Islands, and West Virginia.

    Multiple states have recently made changes to their telehealth policies in an array of policy areas, including their Medicaid programs, private payer laws, professional regulations, and cross-state licensing.  Highlighted changes from this group of states include:
    • CALIFORNIA: Medi-Cal (CA Medicaid) announced implementation of an Alternative Payment Methodology (APM) for participating Federally Qualified Health Center (FQHC). The FQHC APM Program Guide states that FQHCs are eligible to apply with DHCS to participate in the APM. The Guide references telehealth in regard to alternative encounters and includes information around calculating the APM, how alternative encounters will be factored in, and alternative coding guidance. An All Plan Letter and Behavioral Health Information Notice updated Medi-Cal guidance regarding Medi-Cal managed care plans and behavioral health plans utilizing telehealth to fulfill network adequacy requirements for time and distance standards. Another Behavioral Health Information Notice announced coverage of certain community-based behavioral health services and their ability to be provided via telehealth.
    • COLORADO: The Colorado Department of Health Care Policy & Financing (HCPF) has updated its Lactation Services Billing Manual to clarify allowable settings and billing requirements for lactation support services, including via telehealth. Providers may deliver lactation support in the member’s home, clinics, provider offices, or through telemedicine. When provided via telehealth, Place of Service codes 02 (telehealth provided other than in patient’s home) or 10 (telehealth provided in patient’s home) must be used.  Telehealth services must follow the guidance outlined in the state’s Telemedicine Billing Manual. Appropriate modifiers for telemedicine delivery include FQ, FR, 93, and 95, depending on the modality used.
    • GEORGIA:  Passed two bills that impact two professions and how they utilize telehealth to provide services via telehealth. SB 105 made changes to how veterinarians utilize technology to provide services including in prescribing and licensure requirements. The bill also makes a distinction of what “teleadvice,” “teletriage,” and “telemedicine services” mean for the profession.  HB 567 places into statute parameters and requirements on the use of telehealth to deliver dental services. Some of the policies it creates impact consent, referrals, standards, and licensure. HB 567 goes into effect January 1, 2026 and SB 105 has parts that go into effect immediately and others July 1, 2025.
    • MAINE:  MaineCare has released a provider bulletin reminding healthcare professionals that many covered services may be delivered via telehealth, provided certain requirements are met. Telehealth services must be performed over secure telecommunications with adequate encryption to protect patient confidentiality, in compliance with state and federal laws. Providers must use technology sufficient to deliver care effectively and are required to act within the scope of their licensure and follow Medicaid policy. Telehealth remains a voluntary option for members, and providers must offer an in-person alternative without impacting future access to care. When billing, providers should use the standard procedure code with a GT modifier.  Additionally, Maine’s Board of Optometry adopted new regulations outlining standards of practice for telehealth, including consent, licensure, and prescribing requirements. Finally, Maine revised its Controlled Substances Prescription Monitoring Program definition of "prescribe" to include telehealth encounters. Licensed healthcare professionals and veterinarians may now prescribe controlled substances via telehealth to patients located in Maine under certain conditions.
    • MARYLAND:  Maryland enacted HB 869 the Preserve Telehealth Access Act of 2025.  In the act were provisions to remove the temporary allowance for certain audio-only services and make them a permanent option in the Maryland Medicaid program and certain insurers. Additionally, the bill requires, starting in 2026, that the Maryland Health Care Commission report developments in telehealth every four years to the Governor and the General Assembly.  With the passage of HB 345, Maryland joins the Social Work Compact.
    • PUERTO RICO:  A notice released by the Department of Health, states that due to the need of the administering agency to develop and enact a system to provide practitioners with a certification to use telehealth/cybertherapy technologies, the Department of Health is delaying the requirement for additional telehealth certification to December 31, 2025.  This will apply to all professionals licensed by the Division of Licensing of Physicians and Health Professionals as well as the Board of Examiners of Social Work Professionals.
    • WEST VIRGINIA:  Appendix B of the West Virginia Medicaid Provider Manual is no longer available, as the site notes that the state’s telehealth flexibilities officially ended on December 31, 2024.
    Given the nuanced and varied approaches states are taking with their telehealth policies, please reference CCHP’s telehealth Policy Finder to link to additional details and access each states’ policies in their entirety.
    FQHC Telehealth Policy Tracking is Back!

    The Center for Connected Health Policy (CCHP) is excited to announce that our Federally Qualified Health Center (FQHC) telehealth policy category is returning to CCHP’s Policy Finder this summer! We began tracking this important category in the Fall of 2022, but had to pause updates last year when the funding for this work expired. However, thanks to renewed support from the National Association of Community Health Centers (NACHC), we’re once again able to offer this resource to our community.
     
    Stay tuned for the category to reappear in the policy finder on June 30th!
    New Study Explores Mental Health Providers’ Comfort and Challenges with Telemedicine Prescriptions

    A recent study published in JMIR Human Factors and led by researchers from telehealth platform Doxy.me offers new insight into how mental health providers navigate prescribing via telemedicine. In response to regulatory flexibilities introduced during the pandemic, providers have been able to initiate care and prescribe controlled substance medications without requiring in-person visits. To explore provider perspectives, researchers conducted 16 semi-structured interviews with U.S.-based mental health professionals, primarily psychiatrists and physicians practicing in states such as California, Texas, Oregon, and New York. The study found that most providers feel comfortable prescribing via telemedicine when they can stay within their scope of expertise, access necessary patient health information, and comply with legal and professional standards.

    Despite this general comfort, providers reported ongoing frustrations with e-prescribing systems, pharmacy miscommunications, and the challenges of coordinating lab tests and physical exams remotely. These barriers, however, have not prevented telemedicine prescribing. Instead, providers have adopted various workarounds, such as creating structured workflows to support patients and engaging directly with pharmacies to resolve issues. Notably, current flexibilities around prescribing controlled substances without an in-person visit are set to narrow in 2026. Under a proposed DEA rule—still pending finalization—providers would be able to hold a special telemedicine prescribing registration to continue doing so without an in-person exam or meeting one of the current exceptions to the in-person exam in statute.  Other exceptions to an in-person requirement that would apply in 2026 are those for providers working in the Veterans Affair (VA) system (see VA final rule) or under certain circumstances when prescribing buprenorphine (see buprenorphine final rule).  These upcoming regulatory changes could significantly impact provider workflows and prescribing practices. For more details on the study, read the full article.
    Study Highlights Success of Telemedicine in Prehospital Respiratory Emergencies

    A recent retrospective quality analysis published in Nature sheds light on the growing role of telemedicine in emergency medical services (EMS), specifically in managing respiratory emergencies before hospital arrival. Conducted in Aachen, Germany, the study evaluated 2,234 cases between 2019 and 2021 where patients presented with respiratory distress—marked by symptoms like shortness of breath, oxygen saturation below 94%, or elevated respiratory rates—and were managed via a tele-EMS physician system. This system connects paramedics on scene with a remotely located EMS physician who guides clinical decisions in real time. The findings were compelling: vital signs significantly improved following treatment, appropriate medications were administered in line with guidelines, and only 0.63% of cases required escalation to an on-site physician. These results point to the effectiveness of the tele-EMS system in stabilizing patients and maintaining care quality in the critical prehospital setting.

    In contrast, a U.S.-based study titled TeleEMS: An EMS Telemedicine Pilot Program Barriers to Implementation published in Prehospital Emergency Care evaluated a more limited pilot effort implemented during the COVID-19 pandemic. Conducted in a large urban, fire-based EMS system, the pilot was aligned with the Centers for Medicare & Medicaid Services’ ET3 (Emergency Triage, Treatment, and Transport) model, which encourages treatment-in-place for low-acuity 9-1-1 calls. Over a 12-week period in 2021, only 13 teleconsults were attempted, with 7 resulting in successful treatment-in-place, one requiring transport, and five failing due to technology limitations. While the TeleEMS pilot demonstrated feasibility, it also revealed significant barriers to broader implementation, including challenges with paramedic buy-in, patient expectations, equipment reliability, and physician availability.

    Together, these studies underscore both the promise and complexity of integrating telemedicine into EMS workflows. The German model benefited from established systems, strong provider coordination, and a high volume of eligible patients, allowing for routine use in urgent cases like respiratory distress. The U.S. pilot, while promising, highlighted the structural, technological, and cultural hurdles that must be addressed for sustainable scale. As policymakers and health systems continue exploring telehealth integration into prehospital care, these findings serve as important guideposts—emphasizing not only the clinical value of tele-EMS but also the need for coordinated infrastructure, training, and support to ensure long-term success.

    For more details on the German study, read the full article in Nature. To learn about a related U.S. pilot study on prehospital telemedicine, access the full article.
    What’s New at CCHP this Month?

    CCHP is continually working to create helpful informational content to keep those interested in telehealth and related policies up to date via our policy finder, informational factsheets, webinars, reports and email blasts.  As you may already be aware, CCHP regularly distributes a single topic specific email every Tuesday titled “Telehealth Tuesdays”.  If you are not yet on our distribution list to receive these emails, and would like to be added, you can do so by registering on the CCHP website.




    Over the past month, we have curated and featured a series of insightful topics in our Telehealth Tuesday email blasts.  They include:

    JUNE 3, 2025:  Academy of Nutrition and Dietetics Develop Tenets on Telehealth Policy covering tenets developed by a task force comprised of representatives involved in practice, research, payment and licensure meant to guide the Academy of Nutrition and Dietetics on their future telehealth policy positions.

    MAY 27, 2025:  CMS & ONC Release RFI on Strengthening the Health Technology Ecosystem covering a CMS and ONC Request for Information (RFI) related to access to digital health tools, data interoperability, and alignment of health IT infrastructure with value-based care. Released on May 16, 2025, the RFI (Health Technology Ecosystem [CMS-0042-NC]) seeks public input to guide future improvements for Medicare beneficiaries.  Comments are due June 16, 2025.

    MAY 20, 2025: Evaluation of Remote Monitoring Policies and Benefits covering the April 2025 Peterson Center on Healthcare report, Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment which offers policy recommendations to better align RPM coverage with clinical evidence and cost-effectiveness.

    FEDERAL LEGISLATION
     
    Protecting Veteran Access to Telemedicine Services Act of 2025
    HR 1107 (Rep Womack R-AR) – Allows a covered health care professional to use telemedicine to deliver, distribute, or dispense to a patient eligible to receive medical treatment under the Department of Veterans Affairs a controlled substance regardless of whether the health care professional has conducted an in-person medical examination of the patient as long as the health care professional is authorized to prescribe the basic class of such controlled substance under an active current, full, and unrestricted State license, registration, or certification, acts in the usual course of professional practice, and such substance is delivered, distributed, or dispensed for a legitimate medical purpose.  (Status:  5/6/26 – Committee consideration and mark-up session held)

    Expanding Remote Monitoring Access Act
    HR 3032 (Rep. Balderson R-OH) - Requires that the Secretary of Health and Human Services shall ensure that remote monitoring services furnished under Medicare during the period beginning on the date of the enactment and ending on the date that is 2 years after such date of enactment are payable for a minimum of 2 days of data collection over a 30-day period, regardless of whether the individual receiving such services has been diagnosed with, or is suspected of having, COVID–19.  Additionally, it mandates a report from the Secretary of Health and Human Services on the impact of this change and recommendations for future reimbursement models that consider patient needs and costs. (Status: 4/28/25 - Referred to the Committee on Energy and Commerce; and Committee on Ways and Means)

    Health Care Fairness for All Act
    HR 3080 (Rep. Sessions R-TX) - Among other elements, the legislation states that in the case of any provision under section 1834(m) of the Social Security Act (the section that governs Medicare telehealth reimbursement and the current telehealth waivers), that any of the allowances that would have ended on the last day of the emergency period or December 1, 2026, absent this bill, would instead be deemed to continue to apply on or after such last day.  Additionally, it states that beginning on the date of enactment, inpatient hospital services or inpatient critical access hospital services shall include services (including telehealth services as defined in section 1834(m)) furnished to an individual by an Acute Hospital Care at Home Program (as defined by the Secretary).  With respect to telehealth services furnished by an Acute Hospital Care at Home Program, the requirements for the patient to be in a rural area shall not apply and the list of eligible originating sites shall include the home or temporary residence of the individual.  (Status: 4/29/25 - Referred to the Committee on Energy and Commerce, and Committees on Ways and Means, and Education and Workforce)
    ~~~

    STATE LEGISLATION
     
    GEORGIA
    HB 567 – Amends statute relating to licenses for the practice of dentistry, so as to authorize and regulate teledentistry by licensed dentists, including requiring dentists who intend to provide dental care through teledentistry to notify the board of their intent and provide written documentation evidencing that the dentist has a physical office for the provision of services, and established a referral relationship with a referred dentist who practice dentistry and treats patients in a physical and operational dental office located in Georgia.  See bill for additional requirements.  (Status: 5/9/25 – Governor Signed.  Will be effective Jan. 1, 2026)

    ILLINOIS
    SB 2153 – Provides for telehealth practice standards for physical therapists and physical therapist assistants.  The bill allows physical therapists to use telehealth to perform an initial evaluation if the patient has a referral or diagnosis, the patient is an established patient or the physical therapist has the capacity to perform or facilitate a referral for an in-person, hands-on examination or re-examination by a physical therapist at any time throughout the course of the patient’s care.  See bill for additional details.  (Status: 5/23/25 – Third reading)

    MONTANA
    SB 438 - This bill requires Montana boards, oversight entity or department to create an out-of-state provider registration for telehealth or telemedicine providers if the health care provider completes an application, has a current license, registration or active certification, and has not been subject to disciplinary action within a 5-year period. The board may charge a registration fee that may not exceed the fee charged for that type of health care provider when applying for in-state licensure, registration or certification.  (Status: 5/23/25 – Died in process)

    NEVADA
    SB 128 - The legislation mandates that health insurers, including Medicaid and the Children's Health Insurance Program, cannot solely utilize artificial intelligence or automated decision tools to deny, modify, or limit prior authorization requests, modify a request for medical or dental care submitted by a provider of health care, reduce the scope of services or the amount of coverage or terminate, reduce or modify coverage for previously approved medical or dental care. (Status: 5/23/355 – Re-engrossed.  Second reprint)

    SOUTH CAROLINA
    H 3752 - Enacts the Social Work Interstate Compact.  The purpose of this compact is to facilitate interstate practice of regulated social workers with the goal of improving public access to competent social work services. The compact seeks to preserve the regulatory authority of states to protect public health and safety through the current system of state licensure. (Status: 5/22/25 – Signed by Governor.  Effective 5/22/25)

    TEXAS
    HB 1700 - This bill would require each agency with regulatory authority over a health professional providing a telemedicine medical service, teledentistry dental service, or telehealth service to adopt rules necessary to standardize formats for and retention of records relating to patient consent for telehealth, telemedicine and teledentistry, and include provisions based on the appropriate standard of care for consent documentation in an audio-only format.  (Status: 5/23/25 – Sent to Governor)
     

    See original source :https://www.cchpca.org/resources/

By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience.