Today, September 30th, is the last day before the Medicare telehealth waivers expire, unless Congress is able to pass an extension before midnight tonight. As many readers are already aware, on March 14, 2025, the federal telehealth waivers applicable to Medicare, which have been in place since the pandemic, were extended for an additional six months, until September 30, 2025. In recent weeks, several proposed extensions of these waivers have been made within recent budget talks. If no final deal materializes, the result will not only be an expiration of the Medicare telehealth waivers, but a federal government shutdown.
A few temporary solutions, which include an extension for the Medicare telehealth waivers, are on the table:
- S. 2882 and H.R. 5450, which provide an extension of the telehealth waivers to October 31, 2025.
- H.R. 5371, which provides an extension of the telehealth waiver to November 21, 2025.
As of today, it remains uncertain if any of the bills have enough votes to pass in Congress. Right now, you may be wondering what will it mean for telehealth in Medicare if none of these bills or another extension passes before midnight tonight. In short, Medicare policies will revert back to permanent Medicare telehealth policies starting tomorrow, October 1, 2025. This means that certain restrictions will again apply including those on patient location, which providers can act as distant site providers and be reimbursed by Medicare, as well as several other policies that, since the pandemic, have not been enforced. Earlier this summer, CCHP put out a series of newsletters that focus on the impacts of reverting back to permanent telehealth policies:
If the deadline does indeed come to pass, the shift back to permanent telehealth policies will be a significant change for both patients and providers, and the scope of the impacts of the reversion back is currently unknown. For example, if the waiver deadline passes and there is a return to permanent Medicare telehealth policy, but a few days later Congress does pass a bill and a new extension (or permanent change) is enacted, those few days, or the “gap” between expired waivers and any new policy, may not have too significant of an impact, as providers might be able to reschedule most patient visits for a later date. However, the longer the “gap” continues, the more patients and providers will feel the effects. As time goes on, it will become increasingly difficult to reschedule patients, and the uncertainty regarding a resolution will grow. Providers then may only be able to offer an in-person option, which may be difficult for a patient to attend due to time and/or distance, and as a result, the patient may opt to do without the visit or miss it entirely. An additional potential scenario that holds great uncertainty is if there is a significant “gap” period, and down the road another extension is eventually granted, will that gap period be retroactively covered under any new waiver? For example, if a new extension is given for Medicare telehealth policies, but already a month has elapsed during the “gap” period, will Congress include language ensuring the coverage extension captures services provided starting October 1, 2025? At this point, the answer to these and other questions are unknown.
Some readers may also wonder what role the Centers for Medicare and Medicaid Services (CMS) plays in regard to this situation. There is very little CMS can do about the Medicare telehealth waivers as most of those policies are embedded in federal statute and require Congress to act. However, in their 2025 Physician Fee Schedule (PFS), CMS extended for federally qualified health centers (FQHCs) and rural health clinics (RHCs) the ability to continue to use telecommunication technologies to provide non-behavioral health services until the end of 2025. Additionally, within the proposed 2026 PFS, CMS includes that they would extend that policy through the end of 2026. Therefore, if the current September 30th deadline for the Medicare telehealth waivers does come to pass, FQHCs and RHCs will still have the capacity to provide services via technology and be reimbursed by Medicare at least through the end of this year, and potentially even through the end of 2026 if next year’s proposed PFS is finalized as written. However, it is important to highlight that FQHCs and RHCs will have to meet previously waived in-person requirements related to mental health services without the waivers. For more information on this, see CCHP’s Eligible Providers and Mental Health newsletters from the aforementioned Summer Medicare Waiver newsletter series.
In the meantime, what should patients and providers do if the Medicare telehealth waivers expire? For now, this may mean rescheduling ineligible telehealth visits as in-person appointments, or waiting to hold the telehealth visit at a later date entirely. Patients should consult with their providers regarding their options. If a patient is covered by Medicare Advantage, the patient should also inquire with their health plan regarding the potential impacts a waiver expiration will have on their coverage for telehealth visits. The Medicare telehealth waiver policies specifically address Medicare fee-for-service (sometimes referred to as Original Medicare). If you are a patient covered by Medicare Advantage, the telehealth waivers expiring may not impact which telehealth services are covered. This is because Medicare Advantage plans are allowed to offer telehealth coverage that goes beyond Original Medicare. However, many health plans do simply replicate Original Medicare policy, as that is all they are required to do, and in that instance the waivers may impact the telehealth services eligible to be covered under your plan. It is important to confirm with your health plan directly to be certain you understand the full extent of their telehealth coverage policies.
For providers, as noted earlier, the extent of the impact will likely depend on the length of any gap period. A “gap” that only lasts a few days, while causing some inconvenience, could be mitigated by rescheduling appointments to minimize disruptions. However, the longer the “gap” continues, the more difficult the decisions will become. If a provider continues to provide telehealth services that would not ultimately qualify for coverage under permanent telehealth Medicare policy, providers risk not getting paid (keep in mind while its possible some policy is put into place to cover any “gap” period by having an extension cover services retroactively, at this point there’s no guarantee that will occur). Moreover, if providers do choose to provide services that would not ultimately end up being covered during said gap period, they should be certain to provide their patients with an Advance Beneficiary Notice (ABN) of non-coverage ensuring patients are aware they ultimately could end up with costs to cover out of pocket. However, if providers decide not to provide services via telehealth during this hypothetical “gap” period, then there is the added risk of patients not receiving care they need in a timely manner, or not at all. |
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