Lawmakers Miss Deadline to Extend Medicare Telehealth Flexibilities
Lawmakers missed a crucial deadline to extend telehealth flexibilities in Medicare, causing disruptions in virtual care reimbursement and access for beneficiaries nationwide. The federal government shutdown at midnight on Wednesday after Congress failed to reach a consensus on funding legislation. The clash between Democrats and Republicans over extending financial assistance for those purchasing insurance on the Affordable Care Act exchanges was the main point of contention.
Both parties had proposed spending packages to preserve the telehealth policies, with Republicans aiming for a Nov. 21 extension and Democrats pushing for an Oct. 31 extension. However, these bills did not gain traction, leading to the lapse of telehealth coverage flexibilities on Oct. 1. The Centers for Medicare and Medicaid Services (CMS) announced that many previous restrictions on telehealth would resume, giving providers the option to hold off on submitting telehealth claims in the absence of congressional action. In addition, the authorization for the CMS’ Acute Hospital Care at Home program, which allows over 400 facilities in 39 states to provide inpatient level care at patients’ homes, also expired due to the missed deadline.
Telehealth groups have condemned the missed deadline, emphasizing the urgent need for congressional action to reinstate the flexibilities. The Alliance for Connected Care’s executive director, Chris Adamec, expressed concerns about the impact on seniors’ access to essential care, highlighting potential delays, adverse health outcomes, and increased operational costs for healthcare organizations. The American Telemedicine Association’s advocacy arm, ATA Action, sent letters to President Donald Trump and congressional leaders, urging them to restore the flexibilities and implement retroactive reimbursement provisions for clinicians offering virtual care during the lapse period.
The telehealth flexibilities were initially introduced during the COVID-19 pandemic to ensure continued access to care in light of restrictions on in-person interactions. While some telehealth policy changes from 2020 have become permanent, others, such as eliminating geographic restrictions and allowing telehealth for mental healthcare without in-person visits, are still operating under temporary waivers. Efforts to preserve these flexibilities have faced challenges, with Congress authorizing a two-year extension at the end of 2022 but failing to reach a long-term agreement at the close of last year. The recent lapse in coverage underscores the need for clear policy decisions to support telehealth initiatives.
Providers and telehealth advocates have grown weary of the uncertainties surrounding telehealth reimbursement, with frequent missed deadlines causing disruptions and resource allocation challenges. Planning for potential lapses in telehealth coverage consumes valuable resources, as providers must develop contingency plans and communicate potential changes to patients. The current situation necessitates discussions on the risks of providing telehealth services during the government shutdown, as providers await congressional authorization for retroactive reimbursement.
Moving forward, healthcare systems must remain vigilant and seek guidance from the CMS amid the uncertainty surrounding telehealth reimbursement. Providers may need to rely on hope that submitted claims will eventually be paid, highlighting the importance of a clear and stable policy framework to support telehealth initiatives. As the healthcare landscape continues to evolve, addressing the challenges surrounding telehealth reimbursement is paramount to ensure seamless access to care for patients nationwide.
