The 118th Congress has until December 20th to pass a government funding bill or Continuing Resolution (CR) to avoid a shutdown. Hanging in the balance are Medicare telehealth services, which are set to expire at the end of this year. The Drug Enforcement Administration (DEA) has already acted to extend prescribing controlled substances via telemedicine until the end of 2025, but it will be up to Congress to take care of the rest.

CAA Flexibilities Set to Expire

Without Congression action, telehealth services signed into law in the Consolidated Appropriations Act (CAA) of 2023 will expire at the end of the year.

  • Access to telehealth services in any geographic area in the United States, rather than only in rural areas. Beginning January 1, 2025, Medicare will cover most telehealth services only if they are provided by medical offices or facilities in rural areas in the United States.
  • Allowing patients to stay in their homes for telehealth visits that Medicare pays for rather than requiring travel to a health care facility.
  • Allowing certain Medicare telehealth visits to be delivered using audio-only technology (such as a telephone) if someone is unable to use both audio and video (such as a smartphone or computer).
  • An in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter, is not required.

What 2025 Might Look Like

Without Congressional action, beginning January 1, 2025, Medicare coverage of telehealth services for beneficiaries outside of rural health care settings will be limited to:

  • Monthly End-Stage Renal Disease visits for home dialysis.
  • Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke.
  • Treatment of substance use disorder or a co-occurring mental health disorder, or for the diagnosis, evaluation or treatment of a mental health disorder and behavioral health services.
  • Diabetes self-management training.
  • Nutrition therapy.

Where do we stand with getting an extension?

There is bipartisan support to extend the flexibilities and Congress has several bills being proposed, including the ones below. The issue is how to fund the extension, as the Congressional Budget Office (CBO) estimates that extending the telehealth flexibilities will cost the government $2 billion annually. Because of lack of consensus on how to fund an extension, a temporary extension is more likely to happen.

  • R. 7623/S. 3967: The Telehealth Modernization Act of 2024: Would permanently extend certain flexibilities such as Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to serve as the distant site, the home of a beneficiary to serve as the originating site for all services, and all types of practitioners to furnish telehealth services, as determined by the CMS.
  • R. 4189/S. 2016: Connect for Health Act of 2023: Would expand coverage of telehealth services under Medicare. The bills would permanently remove geographic restrictions on originating sites and allow the home of the beneficiary to serve as the originating site for all services, permanently allow FQHCs and RHCs to serve as the distant site, and allow CMS to generally waive coverage restrictions during any public health emergency.
  • R. 8261: Preserving Telehealth, Hospital, and Ambulance Access Act: Would extend key flexibilities through December 2026.