Without Congressional Action, Telehealth Waivers to Expire March 31

Although Medicare’s expanded telehealth waivers—put in place in March 2020—are set to expire on March 31, the draft Continuing Resolution released on March 8 includes an extension of the telehealth flexibilities through September 30, 2025. This extension would also apply to the Acute Hospital Care at Home waiver.

The Center for Connected Health Policy (CCHP), the national telehealth policy resource center, points out in its March newsletter that the passage of the Continuing Resolution is not guaranteed, so it is important for providers to be aware of the policy landscape they may face should the telehealth waivers not be extended.  

Without Congressional action to extend the waivers, stricter geographic and site restrictions will return, meaning only patients in rural areas and certain medical facilities will qualify for Medicare-covered telehealth. Additionally, CCHP notes that while mental health telehealth services will continue beyond April 1, 2025, providers must meet new in-person visit requirements. 

CCHP provided a breakdown of the key changes and what they mean for providers and patients, should the telehealth waivers expire and the Medicare policies default to what is currently in permanent statute. This assumes there is no new legislation that extends or modifies the telehealth waivers:
• Medicare-specific restrictions: The upcoming changes only affect Medicare reimbursement. If Medicare is not the payer, these restrictions do not apply.
• Geographic and site restrictions: Beginning April 1, Medicare will only reimburse telehealth for patients in designated rural areas and certain medical facilities. To check if a location qualifies as rural, use the HRSA Medicare Telehealth Payment Eligibility Analyzer tool. Patients receiving telehealth at home will no longer be covered under standard Medicare rules.  Certain exceptions from these site requirements do exist, including for mental health services (see last two bullet points).
• Distant site provider limitations: Certain professionals, including physical therapists, occupational therapists, speech-language pathologists, and audiologists, will no longer be able to bill Medicare for telehealth services.
• Hospital restrictions: Hospitals are not eligible distant site providers, and Medicare’s hospital-at-home allowances are expected to end.
• Mental health telehealth exceptions: Mental health services will remain covered for patients outside rural areas and medical facilities. However, providers must conduct an in-person visit within six months of the initial telehealth appointment and once every 12 months after that. An exception exists for the subsequent visit requirement if the patient and provider agree that an in-person visit’s risks and burdens outweigh the benefits.
• Special case exceptions: Some services will continue to be reimbursed under Medicare telehealth without the geographic/site restrictions, including:
    • Substance use disorder treatment and co-occurring mental health conditions
    • End-stage renal disease treatment
    • Acute stroke care