In a significant move to support the ongoing integration of telehealth services within the U.S. healthcare system, Congress has extended telehealth flexibilities through 2026 for Medicare users. This extension, part of the “Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025,” ensures that the benefits introduced during the COVID-19 public health emergency (PHE) continue to be available to healthcare providers and patients, particularly Medicare beneficiaries.
Legislative Background and Intent
Prolonging Telehealth Provisions
The legislative action aims to extend critical telehealth provisions that were due to expire on December 31, 2024. By extending these provisions through December 31, 2026, Congress is ensuring that the advancements made in telehealth during the PHE are not lost. This move reflects a recognition of the sustained demand for telehealth services and their integral role in modern healthcare delivery. The continuation of these provisions indicates a significant acknowledgment of the benefits telehealth has provided, particularly in enhancing accessibility and efficiency in healthcare services across the country.
Medicare beneficiaries stand to benefit significantly from this extension. The expanded access to telehealth services means that patients can continue to receive care from the comfort of their homes or other convenient locations. This is particularly important for those in rural or underserved areas where access to healthcare providers may be limited. The sustained availability of telehealth services also caters to patients with mobility issues, chronic conditions, or those needing regular follow-ups, thereby reducing the physical and logistical challenges of in-person visits.
Key Flexibilities Highlighted in the Bill
Expanded Definition of “Originating Site”
One of the critical flexibilities maintained by the legislation is the expanded definition of “originating site.” This definition now includes any location within the U.S., including individuals’ homes. This adaptability permits patients to receive telehealth services from convenient locations, enhancing accessibility and convenience. By redefining this term, the legislation removes geographical barriers that previously restricted where patients could engage in telehealth consultations, making it possible for more people to receive timely and necessary medical care without the need for extensive travel.
The inclusion of homes and other non-traditional settings as originating sites is transformative, especially for those in remote or underserved areas. It paves the way for a more inclusive healthcare system where patients are not disadvantaged by their location. Moreover, this flexibility supports ongoing management of care, particularly for chronic disease patients who require regular monitoring and consultations. This modernization aligns with the growing trend towards patient-centered care, where convenience and access are prioritized, ultimately leading to better health outcomes.
Inclusion of Additional Practitioners
The bill also broadens the definition of “practitioner” to include qualified occupational therapists, physical therapists, speech-language pathologists, and audiologists. This expansion allows a wider range of healthcare professionals to provide telehealth services, thereby increasing the availability of care. By incorporating these practitioners, the legislation recognizes the essential roles they play in a comprehensive healthcare delivery system and ensures that patients have access to a holistic range of services through telehealth platforms.
This inclusivity in the definition of practitioners signifies a broader acceptance of telehealth’s applicability across various medical and therapeutic disciplines. Patients stand to benefit immensely from such an inclusive approach because it ensures that treatment options and care availability are not constrained to just primary care but extend to rehabilitative and specialty care as well. Moreover, this move supports a multidisciplinary approach to patient care, enabling better coordination and comprehensive management of health conditions remotely, which is critical for sustained health improvements.
RHC and FQHC Telehealth Services
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) are authorized to continue offering telehealth services under the extended provisions. This is a crucial measure to ensure that patients in rural and underserved areas have access to necessary healthcare services. RHCs and FQHCs often serve populations that face significant barriers to healthcare access, including geographic isolation, limited transportation options, and resource constraints, making telehealth an invaluable tool for these communities.
Extension of telehealth services in RHCs and FQHCs underlines the government’s commitment to equitable healthcare access. These centers cater to underserved and rural populations who might otherwise lack sufficient healthcare opportunities. By ensuring these clinics can continue to offer telehealth services, the legislation helps bridge the healthcare gap, fostering greater health equity. This support is crucial for maintaining continuity of care in rural areas, ensuring that healthcare delivery remains consistent and patients can receive timely medical attention irrespective of their location.
Mental Health and Audio-Only Telehealth Services
In-Person Visit Requirement for Mental Health Services
The requirement for healthcare providers to conduct in-person exams within six months before initial telehealth services for mental health diagnosis, evaluation, or treatment has been delayed until January 1, 2027. This delay provides flexibility for mental health services, ensuring that patients can continue to receive care without the immediate need for in-person visits. This extension is particularly beneficial for mental health services, where continuity and access to care play pivotal roles in effective treatment and support.
Telehealth has proven to be a vital tool for mental health services, offering patients a safe and convenient means of accessing therapy and support. Delaying the in-person visit requirement acknowledges the unique needs of mental health care, where establishing a therapeutic relationship and consistent support can be more easily managed through virtual means. This provision ensures that patients can continue to receive necessary mental health services without the barrier of scheduling and attending in-person visits, which can be particularly challenging for those in remote areas or with severe mental health conditions.
Extension of Audio-Only Telehealth
The bill extends coverage for telehealth services delivered via audio-only technology. This ensures that patients who may not have access to video-capable devices or high-speed internet can still receive telehealth services, maintaining accessibility for all. By acknowledging the technological limitations that some patients face, particularly in rural or economically disadvantaged areas, the legislation upholds the principle of equitable healthcare access.
Audio-only telehealth is a crucial modality for ensuring that telehealth services are inclusive and accessible. For many patients, video telehealth is not a practical option due to internet connectivity issues or lack of appropriate devices. By continuing to support audio-only telehealth, the legislation ensures that these patients are not left behind and can still access essential medical services. This provision plays a significant role in addressing the digital divide and ensuring that telehealth remains a viable option for a broader population, thus supporting public health goals.
Hospice Care and High-Deductible Health Plans
Recertification of Eligibility for Hospice Care
Telehealth use for face-to-face encounters for hospice care eligibility recertification remains permissible under the extended provisions. This flexibility is vital for patients receiving hospice care, allowing them to continue their care without unnecessary disruptions. Telehealth in hospice care provides a means for healthcare providers to conduct necessary evaluations and support services without the need for patients to travel, which can be physically taxing and emotionally challenging for those nearing the end of life.
The continuation of telehealth for hospice care helps to ensure that patients receive timely and compassionate care. It alleviates the logistical challenges of in-person visits, enabling healthcare providers to maintain consistent contact with patients and their families. This provision supports the goal of delivering high-quality, patient-centered care in hospice settings, ensuring that patients’ needs are met efficiently and empathetically. By leveraging telehealth, providers can offer necessary medical oversight and emotional support, enhancing the overall quality of hospice care.
HDHP/HSA Safe Harbor for Telehealth Services
High-deductible health plans (HDHPs) qualifying for health savings accounts (HSAs) can continue covering telehealth services on a pre-deductible basis from December 31, 2022, to January 1, 2027. This provision supports the financial aspect of accessing telehealth services, making it more affordable for patients. By allowing HDHPs to cover telehealth services before the deductible is met, the legislation alleviates financial barriers, encouraging more patients to utilize telehealth services and seek timely medical attention.
This financial flexibility is instrumental in promoting the use of telehealth, particularly for preventive and routine care. By reducing the out-of-pocket costs associated with telehealth services, the provision encourages patients to opt for virtual consultations, which can prevent deterioration of health conditions and reduce the need for more intensive and costly care later on. This approach aligns with preventive health strategies, fostering an environment where patients can proactively manage their health without the burden of immediate financial concerns.
Additional Requirements and Flexibilities
Required Use of Modifiers
By January 1, 2026, the Secretary of Health and Human Services (HHS) must establish requirements for modifiers in claims for telehealth services delivered through virtual platforms or as incident to physician services. This measure aims to streamline billing and ensure compliance with telehealth service claims. Establishing clear guidelines for the use of modifiers will help create a standardized framework, making it easier for healthcare providers to submit accurate claims and receive appropriate reimbursements for telehealth services.
Requiring the use of modifiers will enhance the transparency and traceability of telehealth services, ensuring that all elements of a telehealth claim are clearly documented and coded. This step is essential for maintaining the integrity of telehealth billing processes and preventing fraud or inadvertent discrepancies. By setting these requirements, the HHS aims to foster a reliable and efficient telehealth ecosystem where providers can confidently navigate billing procedures, and patients can benefit from seamless access to telehealth services.
Acute Hospital Care at Home
Flexibilities allowing acute hospital care in a home setting are extended until 2029. This provision supports the continuation of hospital-level care at home, which has been a critical component of healthcare delivery during the PHE. Allowing acute care at home can significantly reduce the burden on hospital resources while providing patients with comfortable and familiar environments for their recovery and treatment.
The extension of acute hospital care at home reflects the growing acceptance and success of this model of care. By enabling patients to receive high-quality medical care in their homes, the healthcare system can improve patient outcomes, reduce readmission rates, and lower healthcare costs. This provision is particularly beneficial for managing chronic conditions, post-operative care, and other medical needs that can be effectively addressed outside traditional hospital settings. It highlights a shift towards more personalized and flexible healthcare delivery, leveraging technology to provide continuous and comprehensive care.
Changes Under the CY 2025 Physician Fee Schedule Final Rule
Extended Allowance of “Remote Direct Supervision”
The Centers for Medicare & Medicaid Services (CMS) has extended the allowance of “remote direct supervision” through real-time audio and visual interactive communications until December 31, 2025. This extension includes a permanent definition for specific incident-to services, ensuring continued flexibility in service delivery. The provision of remote direct supervision means that healthcare providers can oversee the work of clinical staff in real-time, even when not physically present, thus maintaining high standards of care while optimizing resource utilization.
Extending the remote direct supervision allowance demonstrates a commitment to adapting healthcare practices to contemporary technological capabilities. By enabling real-time oversight via audio-visual communications, the CMS ensures that healthcare services can be delivered efficiently and safely, leveraging telehealth to support various clinical scenarios. This move is particularly valuable in scenarios where immediate guidance and input from senior medical staff are required, thus enabling more effective and responsive patient care. It also supports the continual evolution of telehealth services, ensuring they remain robust, secure, and reliable.
Enrolled Location as “Distant Site” Address
Practitioners can use their enrolled location instead of home addresses for billing telehealth services through December 31, 2025. This provision simplifies the billing process and supports the continued use of telehealth services. By allowing enrolled locations to be used as the billing address, the rule reduces administrative burden and provides greater flexibility for healthcare providers in managing their telehealth services.
Using the enrolled location as the distant site address helps streamline the operational aspects of telehealth practice. This provision removes the need for practitioners to disclose personal addresses, enhancing privacy and security. It also facilitates a more standardized approach to billing, ensuring that telehealth services are appropriately reimbursed without the complexities of varying billing locations. This measure helps to foster a more seamless and efficient telehealth delivery system, supporting the sustained growth and integration of telehealth into routine healthcare practices.
Definition of “Telecommunications System”
Starting January 1, 2025, the definition of “telecommunications system” will permanently include audio-only communication technology for telehealth services under specific conditions. This inclusion acknowledges the ongoing need for diverse modalities of telehealth to ensure broad accessibility. While video consultations remain a key component of telehealth, the formalization of audio-only options ensures that patients who face challenges with video technology can still access necessary healthcare services.
The permanent inclusion of audio-only communication within the definition of telecommunications systems marks a significant step towards inclusive telehealth policy. This decision recognizes the realities faced by many patients, particularly those in rural or low-income areas, who may not have reliable access to video-capable devices or high-speed internet. By legislating the acceptance of audio-only communication technology, the CMS ensures that telehealth remains a viable and effective means of providing care to all patients, regardless of their tech capabilities. This provision reinforces the core principle of accessibility in healthcare, ensuring that telehealth services are equitable and inclusive.
Conclusion
In a notable effort to bolster the integration of telehealth services in the U.S. healthcare system, Congress has extended telehealth flexibilities until 2026 for Medicare beneficiaries. This extension is a significant part of the “Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025.” It ensures the continuation of the benefits that were first introduced during the COVID-19 public health emergency (PHE). These benefits have proven essential for maintaining healthcare access for both providers and patients, particularly those reliant on Medicare. By extending these flexibilities, Congress aims to support a seamless transition from emergency protocols to a more sustainable, long-term telehealth model. This move is expected to enhance healthcare delivery, improve access for senior citizens, and modernize patient care. The integration of telehealth has been crucial during the PHE, and this continued support underscores its importance in the future of healthcare, ensuring that high-quality care remains accessible and convenient for all Medicare users.
