Can kicked down road: telehealth flexibilities extended to 30 September

March 18, 2025 | by

The Friday-passed Continuing Resolution extended telehealth flexibilities once again. This CR extension of a ‘flat’ budget kicked the can once again by extending all existing telehealth provisions until the end of the Federal fiscal year, which is 30 September.

The parts extended are:

  • Medicare telehealth flexibilities for synchronous telehealth, enabling telehealth visits to occur from a wider range of locations, including the patient’s home, and permits additional qualified provider types to deliver virtual care. This includes RHCs and FQHCs (see below) (2207)
  • The Acute Hospital Care at Home Program that allows Medicare-certified hospitals to furnish inpatient-level care in patients’ homes. (2208)
  • The Special Diabetes Program, without expansion. (2102)

The CR also extended funding for community health centers  and teaching health centers that operate graduate medical education programs (2101). However the disparity in funding telehealth versus in-person for rural health clinics (RHCs) or federally qualified health centers (FQHCs) for telehealth, added under the CARES Act 2020, remains.

It does not include an expanded diabetes program, first dollar coverage for High Deductible Health Plan-Health Savings Accounts (HDHP-HSA), telehealth as an excepted benefit, and expanded and in-home cardiopulmonary rehabilitation services, previously covered in earlier budgets.

The challenge remains for the next fiscal year beginning 1 October, and to be debated this summer, to make these Federal telehealth expansions permanent. Telehealth user organizations, their providers, digital health developers, commercial health plans, and investors then can make long term projections based on permanence. That would provide much-needed stability to this part of the industry. ATA/ATA Action Release, Healthcare Brew, FierceHealthcare, 

There are three Congressional bills that make telehealth services permanent but again they separate telehealth into multiple parts and are not comprehensive. From the National Law Review today:

1. Telehealth Modernization Act of 2024 (H.R. 7623) This bill seeks to permanently extend certain telehealth flexibilities that were initially authorized during the COVID-19 public health emergency.

2. Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (H.R. 4189; S. 2016) This bill proposes to expand coverage of telehealth services under Medicare, aiming to remove geographic restrictions and expand originating sites, including to allow patients to receive telehealth services in their homes.

3. Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261) This bill aims to extend key telehealth flexibilities through 2026, including provisions for hospital-at-home programs and ambulance services.

The debate around these services is separate from the debate around teleprescribing controlled substances, which are under the Drug Enforcement Administration (DEA) and Health and Human Services (HHS). These are debated in this week’s and last week’s Perspectives.

Federal budget continuing resolution battle derailed or delayed some telehealth extensions, physician fee increase, PBM reforms (updated 21 Dec)

December 19, 2024 | by

Updated for the final bill passed 21 December. It’s one day to the Friday 20 December shutdown deadline for the expiring Federal budget extension. How can this be? The continuing resolution (CR) that would extend Federal budgets to 14 March 2025 is running into severe headwinds in Congress. Conservative Republicans in both houses, plus President-elect Donald Trump, and DOGE co-heads Elon Musk and Vivek Ramaswamy have come out against the 1,547-page CR.

Nearly all legislators have NOT read it, to no one’s surprise. Instead of a clean CR that extends the budget, it’s hung like a Christmas tree with ornaments like provisions on health care (discussed below).  Among the ornaments: permitting year-round sales of E15 ethanol fuel (a really bad idea), $100 billion in badly needed disaster aid, the rebuilding of the wrecked Francis Scott Key Bridge in Baltimore–and, outrageously, a pay raise for Congress members, the concealment of information given to the House around the events of 6 January 2021 (Section 605), and the refunding of the Global Engagement Center (GEC) in the State Department that censored social media accounts! (Somehow the spending-free requirement requiring AM radio in all vehicles sold in the US, a linchpin of our national Emergency Alert System, was forgotten.) All of these should have been handled in discrete bills passed much earlier (or defunded as planned), reducing the CR to a manageable 100 pages or less. Why wasn’t it?

For context, the current 118th Congress ends on 3 January 2025. New Members will be sworn in on that date if not before (in the case of vacant seats). Control of Congress will remain with Republicans in the House and switch to them in the Senate. The 119th Congress is able to immediately address this on 3 January.

If the government shuts down after Friday–most of it is on vacation or out of session anyway–what continues are essential functions such as the military, government benefits, Medicare, the VA, and law enforcement. Non-essential employees won’t be coming into work. National parks, for instance, will be closed–but it is winter.

In healthcare, what was tossed on the tree at various points:

In telehealth, the American Telemedicine Association (ATA) applauded, perhaps too early, the following measures:

  • 2-year extension of Medicare telehealth flexibilities (Ed.–for geographic and originating sites plus types of providers)
  • 2-year extension of first dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision (Ed.–commercial coverage)
  • 5-year extension of Acute Hospital Care at Home program (Ed.–originally developed during the pandemic. The Hospital at Home Users group has a webinar at 4pm Thursday–direct link to registration– to discuss contingencies around delay or no extension. )
  • Allows cardiopulmonary rehabilitation services to be furnished via telehealth at a beneficiary’s home under Medicare in 2025 and 2026
  • 5-year extension of the Medicare Diabetes Prevention Program (MDPP) Expanded Model through 2030 and allows beneficiaries to participate virtually and in-person (Ed.–This consists of a one year course that promotes dietary changes, physical activity, and other behaviors to help people lose weight. Providers are paid both for sessions attended and weight loss outcomes. The big guns behind this are Teladoc, which has a lot riding on this, and Omada Health.)
  • Enacts the SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

The Medicare physician fee schedule (Medicare PFS) has a 2.5% increase. This counteracts a 2.8% decrease enacted in November.

Bonuses to alternative payment models and a reauthorization of the SUPPORT Act for dealing with the opioid crisis.

PBM reforms. The bonuses would be paid for by transparency requirements for pharmacy benefit management (PBM) companies, including banning spread pricing in Medicaid and ensuring Part D plan sponsors delink PBM fees from the price of a drug. The PBM trade lobby charges that the delinking alone will increase premiums in Part D by $13 billion and benefit drug manufacturers.

Updated: Mario Aguilar in the STAT HealthTech newsletter reported the inclusion of a required GAO report on wearable devices: “Within 18 months, the government accountability office must produce a report on “(1) the potential for such devices to accurately prescribe treatments; (2) an examination of the benefits and challenges of artificial intelligence to augment such capabilities; and (3) policy options to enhance the benefits and mitigate potential challenges of developing or using  such devices.” I sent a few messages trying to figure out what exactly the deal is, but the language has been attached to telehealth legislation since at least May.”

FierceHealthcare 16 Dec, 16 Dec. Fox News  CBS News    

Update 21 December   A much-contracted and simplified bill was passed on Friday 0’dark:30 by first the House then the Senate for the presidential signature. The full text of the bill is here. The healthcare provisions included were in Division C, table of contents on page 91, and extended through 31 March 2025. Only three were extended–the rest have to wait for a bill or bills in regular order:

  • The Special Diabetes Program (Sec. 3102)
  • Telehealth flexibilities (Sec. 3207)
  • Hospital care at home (Sec. 3208)

More to develop when the 119th Congress convenes on 3 January.