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  • Oct 17, 2025

    Telehealth Medicare Updates - Where Do We Stand Post-Waiver Expiration? + AI in Health Care, Professional Perspectives, and more!

    Center for Connected Health Policy
    MEDICARE: Telehealth Policy – Where Do We Stand Post-Waiver Expiration?
    As of October 1, 2025, Medicare telehealth services are once again governed by permanent law, following the expiration of temporary waivers that had been in place since the onset of the pandemic in 2020. As CCHP has highlighted in our newsletters the past several weeks, this occurred because Congress did not pass a federal government spending bill before the September 30 deadline, triggering a shutdown. Legislative language extending Medicare telehealth flexibilities was tied to that funding bill, so in the absence of Congressional action, the temporary waivers expanding telehealth coverage have now expired and the more restrictive permanent statutory requirements took effect. However, it is widely expected that any legislation to end the shutdown will also include telehealth provisions, likely reinstating the waivers—potentially even retroactively to explicitly cover the lapse period. In the meantime, under current law, telehealth Medicare reimbursement is again limited to patients located in rural areas and to those receiving care in a qualifying medical facility, rather than from their homes (except in limited circumstances). Providers can check whether a patient location qualifies as rural using HRSA’s telehealth eligibility tool.  Certain practitioners, such as physical therapists, occupational therapists and speech language pathologists/audiologists are also excluded from coverage now that the waivers have expired. Additionally, for mental health visits, a requirement for an in-person visit six-months prior to an initial telehealth visit and annually thereafter (with some exceptions) went into effect.

    See CCHP’s recent newsletters and fact sheets for a breakdown of the current permanent Medicare restrictions:

    Newsletters:     Fact Sheets:
    CMS CLAIMS HOLD GUIDANCE
    On the morning of October 1, in a special edition of the Medicare Learning Network (MLN) Newsletter, CMS announced that Medicare Administrative Contractors (MACs) should implement a temporary hold on processing telehealth claims for up to 10 business days. CMS explained that when statutory payment provisions are scheduled to expire, the hold is standard practice to prevent the need for large-scale reprocessing if Congress later reinstates policies. CMS also suggested that providers delivering telehealth services that are not currently reimbursable under Medicare policy may want to use an Advance Beneficiary Notice of Noncoverage (ABN) to inform patients of potential nonpayment.  The ten-business day hold expires today, October 14, and therefore MACs will likely start processing the claims again.  However, many anticipate that Congress could act to restore the expired telehealth flexibilities in the coming days or weeks, potentially retroactive to October 1. In the meantime, Medicare providers are taking varied approaches, including:
    • Holding claims until legislation is resolved
    • Shifting visits to in-person settings where possible, or delaying telehealth visits until later in the month
    • Having patients sign ABNs
    • Accepting the risk of nonpayment for telehealth visits
    UPDATES IN CMS EVALUATION & MANAGEMENT (E/M) BOOKLET
    CMS also recently updated its Evaluation and Management Services booklet to reflect changes in the 2025 Physician Fee Schedule. Among the updates are new codes for caregiver training, individual counseling for pre-exposure prophylaxis (PrEP) for HIV, and safety planning intervention, which CMS approved and added to the list of eligible telehealth services in the 2025 PFS.  At the same time, the booklet reinforces that as of October 1, 2025, Medicare has returned to permanent statutory restrictions, including geographic and facility requirements, as well as limits on the types of practitioners who may furnish telehealth services. Importantly, beginning January 1, 2025, CMS clarified that an interactive telecommunications system may include two-way, real-time audio-only communication for telehealth visits to a patient in their home, as long as both the provider and patient are technically able to use the system and the patient consents. However, these audio-only visits remain subject to the geographic, facility, and provider limitations described above. Providers are instructed to continue using POS codes 02 and 10, and modifier 95 for outpatient therapy services delivered via telehealth.  It is important to note, however, that with the expiration of the waivers, physical therapists, occupational therapists, and speech-language pathologists are no longer eligible to deliver telehealth under Medicare. For more details, via the full updated CMS Evaluation and Management Services booklet.

    LOOKING AHEAD
    The path forward for Medicare telehealth remains uncertain. While the permanent statutory requirements are now in effect, there is significant pressure on Congress to act, and historically such lapses have been temporary. CCHP will continue to monitor developments closely and provide updates as changes occur.

    CCHP also created an FAQ resource and a chart that breaks down the policies on Medicare currently:

    NEW(ish):  MONTHLY COLUMN IN THE CCHP NEWSLETTER:
    Did you know that over the last calendar year CCHP received over 1,000 technical assistance questions?  Believe it or not, we read and responded to every single one.  You should also know that these telehealth policy questions and concerns that you bring to our attention help to inform our future focus areas - all the while, also helping us to keep a pulse on the issues that remain complicated and unclear across the telehealth policy landscape.  The questions we receive range from basic telehealth 101, all the way to incredibly nuanced and complex scenarios.  Beginning last month, we will regularly feature one policy question that we think may be of value to the many telehealth policy enthusiasts out there... including you!
    Federal Agencies and Congress Turn Their Attention to AI in Health Care
    The federal government is actively seeking public input on the role of artificial intelligence (AI) in health care and beyond. The Food and Drug Administration (FDA) recently announced that its Digital Health Advisory Committee will convene on November 6, 2025, to discuss Generative Artificial Intelligence-Enabled Digital Mental Health Medical Devices. This full-day public meeting will explore the benefits, risks, and regulatory considerations of using generative AI to address the growing demand for mental health services. The Committee is expected to provide recommendations on issues such as safety, premarket evidence, post-market monitoring, and risk mitigation. Comments submitted to the FDA by October 17, 2025, will be included in the Committee’s deliberations, though submissions after that date will still be considered.  Comments are being accepted through the Federal Register.

    Additionally, the FDA has issued a request for public comment on measuring and evaluation AI-enabled medical device performance in the real world.  The request is to receive public comment or feedback on a series of questions related to approaches to measure and evaluate the performance of AI-enable medical devices. The questions are related to performance metrics and indicators, real-world evaluation methods and infrastructure, post market data sources and quality management, among other topics.  Comments are due December 1, 2025 and instructions on how to submit comments can be found on the FDA website. 

    At the same time, the White House Office of Science and Technology Policy (OSTP) has issued a broad Request for Information (RFI) seeking feedback on how existing federal statutes, regulations, and agency rules may be hindering AI innovation and adoption. The RFI highlights challenges such as regulatory mismatches, structural incompatibilities, and lack of clarity that can slow the development or deployment of AI systems. OSTP invites all interested parties—including industry, academia, government, and the public—to share examples of outdated or conflicting rules and to suggest solutions, including administrative waivers, exemptions, or regulatory reforms. Responses are due by October 27, 2025, and may help shape federal priorities on AI governance.  Responses to the RFI are being accepted through the Federal Register.

    Congress is also weighing in on the intersection of AI and health care delivery. Two recent House resolutions—H.Res. 704 and H.Res. 694—express concern over the use of AI in Medicare coverage determinations. H.Res. 694 specifically calls on the Centers for Medicare & Medicaid Services (CMS) to halt a pilot program that contracts with private companies to use AI in evaluating Medicare coverage decisions, citing risks to seniors’ access to critical care. H.Res. 704, on the other hand, expresses disapproval of the Wasteful and Inappropriate Services Reduction (WISeR) Model, finding prior authorization processes, including the use of AI to undermine access to timely and necessary medical care, has the potential to limit beneficiary access. Together, these actions highlight the growing scrutiny over how AI is integrated into federal health programs, underscoring the need for balanced approaches that encourage innovation while safeguarding patient access and safety.

    For more on each of the items mentioned above, see below:

    Ethical and Professional Perspectives on Telehealth: Insights from ACOG and AOA
    Telehealth continues to transform the delivery of health care, offering opportunities to expand access, reduce barriers, and create new models of patient engagement. At the same time, professional associations are carefully weighing its ethical and clinical implications. Recently, the American College of Obstetricians and Gynecologists (ACOG) and the American Optometric Association (AOA) issued detailed documents on the use of telehealth in their respective specialties. Although these documents are not laws or regulations, they represent influential guidance that state legislatures, licensing boards, and regulatory agencies may consider as they shape future telehealth policies.

    TELEHEALTH IN OBSTETRICS & GYNECOLOGY
    ACOG published its article on the Ethical Considerations with Telehealth in Obstetrics and Gynecology in September.  They frame their approach through the four foundational principles of medical ethics: beneficence, nonmaleficence, autonomy, and justice. The organization highlights that telehealth can improve outcomes by expanding prenatal and gynecologic care, supporting management of pregnancy-related conditions such as hypertension and diabetes, and reducing non-medical burdens like travel, childcare, and missed work. Research also shows high patient satisfaction with hybrid models of care that combine in-person and virtual visits. However, ACOG cautions that telehealth must only be used when safe and effective, with protocols in place to recognize symptoms requiring in-person follow-up. Physicians are urged to use secure platforms, address privacy concerns openly, and avoid creating situations where patients feel pressured into telehealth over in-person care. Equity is also central to ACOG’s position, as disparities in broadband access, technology literacy, and reimbursement policies risk leaving vulnerable groups behind.

    TELEHEALTH IN OPTOMETRY
    The AOA’s newly revised position statement (initially published in 2020, with revisions approved in August 2025), similarly affirms its support for telemedicine when it expands access, strengthens coordination of care, and protects equity, but insists that the standard of care must remain identical to that of in-person services. Direct-to-patient eye and vision-related applications, based on current technologies and uses, cannot replace or replicate a comprehensive eye exam provided by a doctor of optometry, though they may provide data related to elements of a comprehensive eye exam. Cases for when telemedicine may be particularly useful in optometry include triaging urgent cases, remotely monitoring chronic conditions, or managing straightforward clinical decisions. Safeguards include informed consent, HIPAA-compliant technology, licensure in the state where the patient is located, and clear documentation of patient health records. The AOA also emphasizes the need for training programs, referral networks for urgent and emergency care, and liability protections to ensure safe implementation.

    COMPARISON & IMPLICATIONS
    The statements from ACOG and AOA underscore a common message: telehealth should complement, not replace, in-person care. Both organizations emphasize the importance of preserving the doctor-patient relationship, ensuring patient choice, and maintaining continuity and safety. ACOG’s statement reflects the complexity of health care by embedding its guidance in ethical frameworks that address systemic barriers, privacy concerns, and autonomy. The AOA, on the other hand, places strong emphasis on protecting the integrity of the comprehensive eye exam, preventing fragmented care, and safeguarding against commercial models that may prioritize convenience over quality. Both organizations highlight reimbursement parity, equity, and licensure compliance as essential for ensuring fair and consistent access. While these are professional statements rather than binding rules, their influence is significant. State policymakers and licensing boards may look to this guidance when updating telehealth standards, meaning these perspectives could shape the future landscape of telemedicine well beyond the fields of obstetrics, gynecology, and optometry.  For more details on both organizations positions on telehealth, read their positions in their entirety:  ACOG Ethical Considerations Document & AOA Position Statement

    ATA Launches Digital Infrastructure Score to Benchmark Community Readiness for Telehealth
    The American Telemedicine Association (ATA) has unveiled an enhanced Digital Infrastructure Score (DIS), a first-of-its-kind benchmarking and mapping tool designed to measure digital readiness at the county and ZIP code level. The DIS evaluates critical infrastructure factors—such as broadband access, internet speeds, device availability, and affordability—and applies weighted scoring to reveal how well communities are prepared to adopt telehealth and digital health services. Featuring a user-friendly heatmap interface, the platform enables stakeholders to identify barriers, guide broadband investment, and strengthen policy and funding proposals. Supported by a grant from the Peterson Health Technology Institute, this tool aims to help health systems, policymakers, and community leaders improve access and equity by making digital readiness visible and actionable, particularly for rural and underserved areas.  For more information, see the full press release, and check out the tool itself [must submit contact information to access tool].

    Study Finds Gaps in Same-Day Mental Health Access for Telehealth Patients
    A new Veterans Administration (VA) study published in the Journal of General Internal Medicine analyzed more than 1.2 million Veterans who initiated primary care–mental health integration (PCMHI) services between 2018 and 2023. The study sought to examine the associations between receiving telehealth services and same-day access to integrated mental health services within primary care (PCMHI). Same-day access, defined as a mental health visit on the same day as a primary care visit, was 86% less likely for telehealth patients, underscoring challenges in coordinating warm handoffs between primary care and mental health teams in virtual settings.  Researchers found that patients whose first PCMHI visit occurred via telehealth—either by video or phone—had significantly lower odds of receiving same-day access compared to those seen in person.

    Despite these challenges, the study highlights the important role of telehealth in expanding access to care across the VA and notes steady improvement in same-day access over time. By FY22–23, the odds of same-day access for telehealth patients had nearly doubled compared to the early pandemic period, reflecting efforts by clinics to refine workflows and better support remote care. Still, in-person visits continued to offer higher rates of same-day access. The authors emphasize the need for further research to determine whether these gaps stem from patient or provider preferences or from systemic barriers such as scheduling and workflow limitations. They point to adequate staffing, streamlined workflows, and enhanced coordination technologies as key strategies to ensure Veterans using telehealth receive timely mental health care.  For more information, see the full study article.

    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 Connecticut, Delaware, Maryland, Michigan, New Jersey, Pennsylvania, West Virginia.  In addition, CCHP is hard at work on our annual 50-state report—a comprehensive summary of telehealth policies across all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. The report is expected to be released in late October, so stay tuned for its publication.

    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 requirements.  Highlighted changes from this group of states include:
    • CONNECTICUT:  Connecticut Medicaid added coverage for medical nutrition therapy services, including services provided via synchronized telemedicine. Medicaid coverage was also added for doulas and certain doula services rendered via telemedicine. Connecticut also enacted HB 7181, effective October 1, 2025, to ensure cannabis retailers have a licensed pharmacist readily available to provide telehealth consultations for qualifying patients and caregivers in certain instances. HB 7157 requires a Mental and Behavioral Health Awareness and Treatment Pilot Program to be established by the Department of Education no later than January 1, 2026. The program shall enable not less than one hundred thousand students in such districts to utilize an electronic mental and behavioral health awareness and treatment tool through an Internet web site, online service or mobile application, which tool shall be selected by the Commissioner of Education and provide certain services, including private online sessions with mental or behavioral health care providers licensed in the state who have demonstrated experience delivering mental or behavioral health care services to school districts serving both rural and urban student populations. SB 1295 was additionally enacted and creates a number of broadband requirements, including requiring affordable broadband internet access service to have speeds and latencies sufficient to support distance learning and telehealth services.
    • DELAWARE: Passed SB 101 to resolve a conflict between the Uniform Controlled Substances Act which requires an in-person examination to prescribe controlled substances for treatment of Opioid Use Disorder (OUD) and Delaware's telehealth regulations, the Telehealth Access Act which does not require an in-person examination. This bill connects and clarifies the two regulations by modifying the "patient-practitioner relationship" definition in Chapter 47, Title 16, the Uniform Controlled Substances Act, to include a practitioner treating OUD via telemedicine with Schedule III through V medication. This short addition includes: limiting the medication to only Schedule III through V, which has been approved by the FDA for the treatment of OUD and citing to the requirements for establishing a provider-patient relationship under Section 6003 of Title 24, the 2021 Telehealth Access Act, which addresses requirements such as standard of care, medical record keeping, consent, and medical board oversight. Delaware also enacted the Social Work Licensure Compact through SB 109. Meanwhile, the Board of Pharmacy adopted a temporary regulation, effective July 1, 2025 for 120 days, to implement the temporary practice of out-of-state pharmacists in Delaware, due to the anticipated mass closure of Rite Aid pharmacies in Delaware presenting “emergency circumstances” and warranting application of the licensure exemption. The regulation states that offsite pharmacists are authorized to enter and verify patient data and conduct telehealth services from a remote location if the patient is on site at the pharmacy.
    • MARYLAND:  Maryland Medicaid finalized permanent coverage of Assistance in Community Integration Services (ACIS) through telehealth and extended telehealth flexibilities.  In addition, the state extended key flexibilities, announced in a bulletin, which was required under the Preserve Telehealth Access Act of 2025 (HB 869/SB 372)—making audio-only coverage and payment parity permanent for both Medicaid and private payers.  This had previously been set to sunset on June 30, 2025.  CMS also approved a Maryland Medicaid State Plan Amendment waiving the Four Walls requirement for Outpatient Mental Health Centers, allowing services to be billed at clinic rates even when both patient and provider are offsite. Maryland expanded remote patient monitoring (RPM) by adding new RPM and self-measured blood pressure (SMBP) codes, eliminating prior authorization for fee-for-service Medicaid, and broadening eligibility to include participants with a wider range of conditions. Maryland Medicaid also released a transmittal providing coverage for remote ultrasound and fetal nonstress testing for eligible pregnant participants. Finally, in regard to Medicaid, Maryland enacted HB 553/SB 94, requiring Medicaid coverage of maternal health self-measured blood pressure monitoring. Maryland also passed HB 1474 creating a temporary telehealth license under the State Board of Professional Counselors and Therapists, permitting certain out-of-state providers to deliver counseling services to students. The Board of Nursing is also required to pursue reciprocity discussions with neighboring states for advanced practice nursing licensure and certification (HB 602/SB 407). Maryland also passed HB 675/SB 669 modifying the Rape Kit Testing Grant Fund, expanding allowable uses to include peer-to-peer telehealth programs.  In addition, Maryland joined the Social Work Licensure Compact by passing HB 345/SB 174.
    • MICHIGAN:  Michigan adopted new telehealth practice standards for speech-language pathologists. The rules require providers to obtain and document patient consent prior to delivering telehealth services and to maintain proof of consent in the patient’s medical record. Telehealth services must be delivered within the provider’s scope of practice and meet the same standard of care as in-person treatment. The regulations also clarify supervision requirements for certain physically invasive procedures, ensuring they are performed only under appropriate physician oversight and in settings equipped to safeguard patient safety.
    • NEW JERSEY: New Jersey Medicaid released a newsletter (Vol. 35, No. 4) referencing the development of a statewide Mobile Crisis program to provide in-person response for adults (18 or older) who contact the 988 Suicide & Crisis Lifeline. Mobile Crisis Outreach Response Team (MCORT) providers will respond to non-life-threatening mental health, substance use and suicidal crises in the community. Billing scenarios are provided in newsletter for when services are provided by telehealth. However, it is additionally noted that providers will not receive payment and funds will be redirected to the state budget, as this initiative is designed to fund and support state organizations and programs that provide critical behavioral health and crisis-based services to New Jersey consumers.

    See original resource at : https://www.cchpca.org/resources/

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