| Medicare Telehealth Flexibilities at Risk of Expiration: What You Need to Know |
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As the December 31, 2024 expiration date for Medicare telehealth flexibilities looms, stakeholders in healthcare are closely watching and waiting for Congress to take action. These flexibilities, originally established during the COVID-19 public health emergency (PHE) and extended by H.R. 2617 in December 2022, have been instrumental in expanding access to telehealth services. Without further legislative intervention, Medicare's telehealth policies will revert to pre-PHE requirements on January 1, 2025, significantly restricting telehealth's scope.
What Happens if Flexibilities Expire?
Last week, CCHP published a newsletter outlining the Medicare policies set to be reinstated if Congress fails to act. Below is an abbreviated summary (refer to the full write-up for detailed information) of telehealth flexibilities waived during the COVID-19 emergency and expected to go back into effect should no further action be taken by Congress:
- Location Restrictions: Non-mental health telehealth services will only be reimbursable if the patient is located in a specific medical facility in a rural area (except for services delivered for purposes of treating substance use disorder, end stage renal disease (ESRD) treatment or acute stroke). Telehealth for non-mental health services provided to patients in their homes will no longer be covered under Medicare (except for ESRD treatment or treatment for substance use disorder).
- Provider Eligibility: Occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) are not recognized as eligible telehealth providers under Medicare’s permanent law. Consequently, reimbursement for their telehealth services will end, unless billed incident-to another eligible provider. Federally qualified health centers (FQHCs) and rural health clinics (RHCs) are also not authorized providers, though the Centers for Medicare & Medicaid Services (CMS) has created an avenue for them to bill for interactive telecommunication services through the code G2025 in the 2025 physician fee schedule (see CCHP’s CY 2025 PFS factsheet for more information).
- Mental Health Services: Mental health services will remain eligible for telehealth reimbursement without the location restrictions attached. However, there will be a strict in-person requirement:
- Patients must have an in-person visit with their practitioner within six months of their initial telehealth appointment.
- Subsequent in-person visits will be required every 12 months unless the patient and provider agree that the risks and burdens of in-person care outweigh the benefits.
Potential Legislative Fixes
Several bills have been introduced in Congress to extend or make permanent the telehealth flexibilities (i.e. flexibilities waiving the requirements around location, provider eligibility and mental health described above), with bipartisan support. The most current promising avenue, according to an Inside Health Policy news article [subscription required] is that a two-year extension of the Medicare telehealth flexibilities will pass along with a two-year extension of most expiring programs and No Surprise Act funding. Other bills proposed earlier in the year include:
What’s Likely to Happen?
While there is strong bipartisan support for extending telehealth flexibilities, there are no guarantees. Historically, extensions have been included in larger appropriation bill packages passed at the end of Congressional sessions. This scenario could play out again in late December 2024, but it is far from certain. The potential lapse of telehealth flexibilities threatens to disrupt care for millions of Medicare beneficiaries, particularly those in rural areas or those receiving care from OTs, PTs, and SLPs. As the deadline approaches, all eyes will be on Congress to ensure telehealth remains a viable and accessible option for Medicare beneficiaries. We should have a definitive answer about whether or not the telehealth Medicare flexibilities will expire by December 20, when Congress is expected to adjourn for the year. For a comprehensive overview of what the telehealth policy landscape will look like if Medicare flexibilities expire, refer to CCHP’s full write-up.
Please join CCHP for our next webinar on January 9, 2025 where we will review what the current Medicare telehealth policy environment looks like at that time. This webinar will be held jointly with the National Consortium of Telehealth Resource Centers. REGISTRATION is free, but space is limited. Stay tuned to future CCHP newsletters for policy updates on this issue. |
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DEA Extends Telehealth Controlled Substance Allowances Through 2025 |
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The U.S. Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) have announced a third extension of the telemedicine flexibilities for prescribing controlled substances, originally introduced during the COVID-19 public health emergency. This waiver, which was previously scheduled to end on December 31, 2024, will now remain in effect through 2025. This means that DEA-registered practitioners can continue prescribing Schedule II-V controlled substances via telemedicine without conducting an in-person medical evaluation. In the temporary rule published in the Federal Register, the DEA and HHS emphasized the need for additional time to develop regulations that prioritize public health and safety while mitigating the risk of controlled substance diversion. In the meantime, this extension ensures continuity of care for patients and a smooth transition for providers as they prepare to align with future regulations.
A few caveats to be aware of:
- The prescriptions must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice and must result from communication using an approved interactive telecommunications system that meets DEA/HHS standards.
- The extension does not waive the DEA’s requirement to have a separate registration in each state where a controlled substance is manufactured, distributed, imported, exported, or dispensed.
- The DEA requires a physical address in the state for registration purposes.
See the DEA’s Frequently Asked Questions on registration for more information. For more details on the temporary rule on the third extension of the DEA flexibilities, see the full text in the federal register. Updates on future rules that enact prescribing policy for controlled substances beyond 2025 will be provided as they become available. |
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VA Expands Telehealth Access for Rural Veterans
The U.S. Department of Veterans Affairs (VA) has announced a groundbreaking initiative to enhance telehealth services, particularly for Veterans in rural and underserved areas. Key highlights include:
- VA plans to remove copayments for all telehealth services, reducing financial barriers for Veterans seeking remote care.
- The Accessing Telehealth through Local Area Stations (ATLAS) program will provide funding for non-VA facilities, including nonprofits and private businesses, to establish telehealth access points (TAPs). These spaces will offer Veterans private, technology-equipped environments with high-speed internet to connect with VA providers. Grants will also support training on-site staff to assist with telehealth operations.
The above initiatives build on the VA’s efforts to expand healthcare access while leveraging telehealth. Some other recent efforts include enhancing tele-emergency care availability and extended clinic hours. For further details on this initiative, visit the VA Telehealth Services website. |
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Telehealth and Medicaid Updates in the New Hospital Outpatient Payment Rule
The Centers for Medicare & Medicaid Services (CMS) recently finalized updates to the Hospital Outpatient Prospective Payment System (OPPS) for 2025, highlighting significant changes to telehealth policies. CMS explains in the new rule that because telehealth services provided by physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) will no longer be reimbursable starting in 2025 (assuming no law is passed to extend the waivers prior to Jan. 1, 2025), they will likewise no longer pay for outpatient therapy, Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy (MNT) when furnished remotely by hospital staff to beneficiaries at home. Similarly, the rule clarifies that CMS will align with Medicare fee-for-service payment policy and the in-person visit requirements will apply for mental health services furnished remotely by hospital staff to beneficiaries in their homes through communications technology beginning January 1, 2025. They acknowledge that they may consider modifying the policy in future rulemaking (likely if Congress further extends the telehealth Medicare flexibilities described in this newsletter’s first article).
CMS further explains in the rule that they have opted not to recognize new telemedicine-specific evaluation and management (E/M) codes under OPPS. Hospitals must continue billing telemedicine-related E/M services under HCPCS code G0463, as separate payment for these codes was not finalized under the PFS. CMS, however, did choose to extend the allowance for direct supervision of outpatient services, such as cardiac rehabilitation via real-time audio-video communication through December 31, 2025, again aligning with the decision in the 2025 PFS to also extend it.
Notably, CMS has revised Medicaid clinic services regulations to allow Indian Health Services (IHS)/Tribal clinics to deliver services outside their physical facilities while remaining eligible for Medicaid coverage. This is significant for telehealth, because the utility of telehealth is often allowing providers to meet patients where they are, rather than within the walls of their facility. Additionally, states have the option to extend Medicaid coverage for services provided beyond the physical boundaries of behavioral health clinics or facilities situated in rural areas. To address rural-specific needs, CMS has established a flexible framework for defining "rural areas," enabling states to adopt definitions either from federal agencies for programmatic use or from state agencies involved in rural health policymaking. For more information, see the OPPS Final Rule in its entirety. |
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Supreme Court to Decide on FCC's Universal Service Fund
According to an article [subscription required] published on Law360, the U.S. Supreme Court has agreed to review the legality of the Federal Communications Commission’s (FCC) Universal Service Fund (USF), a program established in the 1990s to support subsidized telecommunications services for low-income households, schools, rural healthcare providers, and libraries. The USF has played a critical role in enabling telehealth by ensuring rural healthcare facilities and providers in underserved areas have the broadband infrastructure needed to deliver remote care, particularly during the COVID-19 pandemic. Funded by fees imposed on telecom companies, which are often passed on to consumers, the USF is managed by the Universal Service Administrative Co. (USAC) under FCC oversight.
At issue is whether Congress improperly delegated taxing authority to the FCC and whether the FCC’s reliance on a private entity to administer the fund violates constitutional principles. This legal battle follows conflicting rulings from federal appeals courts. In July, the Fifth Circuit ruled the USF’s structure unconstitutional, citing improper delegation of authority and its reliance on USAC. Conversely, the Sixth and Eleventh Circuits upheld the program, finding that Congress provided the FCC with adequate guidance under the “intelligible principle” standard. The Supreme Court’s decision is expected to resolve this split and could have significant implications for millions who rely on subsidized communications services.
The case also raises broader questions about the delegation of authority and the use of private entities to manage public programs. If the Court rules against the FCC, it could reshape how federal agencies structure similar initiatives in the future. For now, the USF remains in place, but its future hangs in the balance as the Supreme Court prepares to weigh in. The cases under review are FCC v. Consumers' Research et al. and SHLB Coalition et al. v. Consumers' Research et al., with a decision expected next year. Stay tuned to CCHP newsletters for updates for news of the Supreme Court’s decision on these cases. |
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Joint Commission 2025 National Patient Safety Goals for Telehealth
The Joint Commission recently released their 2025 Telehealth National Patient Safety Goals. The Joint Commission develops safety goals tailored to specific programs, which address critical safety issues, informed by expert insights. These goals guide standards, surveys, and educational resources to enhance telehealth quality and safety. The 2025 goals identified for telehealth include:
- Identify patients correctly: Use at least two identifiers, such as name and date of birth, to ensure accurate treatment and medication delivery.
- Improve Staff Communication: Ensure timely communication of important test results to the appropriate staff, supporting prompt and accurate clinical decisions.
- Use Medicines Safely:
- Document and share accurate information about a patient’s current and new medications.
- Provide written instructions for medication use.
- Encourage patients to maintain and bring an updated medication list to each medical appointment.
- Identify Patient Safety Risks: Focus on reducing risks for suicide through assessment and intervention.
- Improve Health Care Equity: Recognize and address disparities in patient care by developing and implementing written plans to promote health equity.
These goals emphasize the importance of accuracy, communication, medication safety, risk reduction, and equity in delivering telehealth services to enhance patient outcomes and safety. For more details on the goals, see the full telehealth chapter. |
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Latest Developments in CCHP’s Telehealth Policy Finder and Policy Trend Map
CCHP’s Telehealth Policy Finder look-up tool and Policy Trend Maps were updated throughout the past month based on the latest information from our ongoing state telehealth policy tracking. The latest states to be updated include Alabama, Alaska, Arkansas, Arizona, Florida, Kansas, Kentucky, Louisiana, Maine, Maryland, Minnesota, New Mexico, Montana, North Dakota, Ohio, Oklahoma, Rhode Island, Utah, Vermont, West Virginia, and Wyoming.
Over the past month, multiple states made changes to their telehealth policies in an array of policy areas, including their Medicaid programs, professional regulations, and cross-state licensing. Highlighted changes from this group of states include:
- ALASKA: Passed Senate Bill 91 which specifies that a physician licensed in another state or an out-of-state member of the physician’s multidisciplinary care team may provide health care services through telehealth to a patient located in Alaska, and that the member of the multidisciplinary care team would be subject to disciplinary action in Alaska, in such a circumstance. Alaska also joined the Social Work Compact.
- ARIZONA: Passed Senate Bill 1267 which provides that general supervision of physical therapy assistants by physical therapists includes supervision provided through telehealth. Arizona also joined the Social Work Compact.
- FLORIDA: Enacted House Bill 849 which explicitly allows a veterinarian who holds a current license in Florida to practice veterinary telehealth. The bill states that the practice of veterinary medicine is deemed to occur when either the patient, veterinarian or both are located within Florida. It also specifies that veterinarians using telehealth must practice in a manner consistent with his or her scope of practice and prevailing standard of practice. The bill does allow an initial patient evaluation to establish a relationship if synchronous audiovisual communication is utilized. See bill for additional details.
- KANSAS: Kansas Medicaid issued a bulletin announcing that retroactive to May 1, 2022, the Telephone Evaluation and Management codes (99441, 99442, 99443) must be billed with Place of Service (POS) code 02 (Telehealth Provided Other than in Patient’s Home) or 10 (Telehealth Provided in Patient’s Home) when services are provided within a Certified Community Behavioral Health Clinic (CCBHC).
- LOUISIANA: Passed House Bill 896 which requires Medicaid coverage for remote patient monitoring (RPM) services for patients with one or more chronic conditions, including sickle cell disease, mental illness, asthma, diabetes, cancer, and heart disease, have a recent history of costly services due to the chronic condition as evidenced by two or more hospitalizations and have a recommendation from their healthcare provider for disease management services through RPM. See bill for details about the eligible RPM services. Louisiana also joined the Social Work Compact.
- MAINE: Maine Medicaid issued a bulletin clarifying that for targeted case management services, text messaging is not an acceptable method to deliver services, as it is not a form of audio-only telephone communication, nor is it a form of real-time, interactive visual and audio telecommunication. Since text messaging does not meet the standard for Telephone or Interactive Telehealth Services, text messaging is not an approved form of delivering services via Telehealth.
- MARYLAND: Maryland Medical Assistance Program issued a transmittal in October announcing that telehealth flexibilities, including coverage of audio-only phone conversations, will continue at least through June 30, 2025. Note that providers must use HIPAA compliant technology products according to the transmittal. Maryland Medical Assistance Program also issued another transmittal clarifying that the federal four walls rule does not allow Medicaid to reimburse a freestanding clinic if neither the practitioner nor patient is physically onsite at the clinic (see transmittal for applicable provider types). However, the transmittal states that the MD Department of Health has submitted a waiver amendment for an exemption from the four walls requirement and, if approved, would allow clinics to bill telehealth services regardless of whether the practitioner or patient is physically onsite at the clinic. Maryland Medicaid also issued transmittals addressing telehealth coverage for doula services and mobile crisis team services.
- NEW MEXICO: The New Mexico Medical Assistance Division (MAD) issued a new Supplement providing guidance for applied behavior analysis (ABA) services. The guidance specifies that MAD allows and encourages the utilization of telemedicine to deliver MAD ABA services to assist Autism Evaluation Practitioners (AEPs) and Autism Practitioner (AP) agencies provide cost effective and home and community-based services to rural and frontier areas of New Mexico.
- NORTH DAKOTA: North Dakota Medicaid released a new policy document addressing preventive services and chronic disease management for early and periodic screening, diagnostic and treatment (EPSDT). The document specifies that preventive medicine counseling and risk factor reduction may be rendered via telehealth. Additionally, Screening, Brief intervention and Referral to Treatment (SBIRT) may be rendered via telehealth if providers document member pre-screening and the member’s score which indicates the need for a full screen.
- OHIO: Medicaid regulations for doula services were added to Ohio’s administrative code. The regulations allow coverage for antepartum and postpartum support services, including consultation and telehealth visits. The Chemical Dependency Professionals Board also adopted new regulations detailing a code of ethical practice for telehealth services. It specifies that licensees or certificate holders must provide services within their scope of practice and that no initial in person or face to face audiovisual visit is necessary to initiate using telehealth modalities, though providers must screen each client for appropriateness to receive services via telehealth. Ohio also joined the Physician Assistant Compact.
- RHODE ISLAND: Rhode Island joined several new licensure compacts, including the Physical Therapy Compact, Audiology and Speech Language Pathology Compact, Social Work Compact, Counseling Compact and Occupational Therapy Compact.
- WEST VIRGINIA: Adopted an emergency rule to ensure access to forensic exams, including through “teleSANE” which means certified sexual assault nurse examiner with documented expertise who provides forensic exam guidance through telehealth technology and is an approved provider by the SAFE Commission.
- WYOMING: The Board of Dental Examiners adopted new teledentistry practice standards. The standards specify that the practice of dentistry occurs where the patient is located. Where an existing dentist-patient relationship is not present, a licensee must take appropriate steps to establish a dentist-patient relationship in utilizing teledentistry services that is consistent with the prevailing standard of care. See regulations for additional requirements.
Given the nuanced and varied approaches states are taking with their telehealth policies, please reference CCHP’s telehealth Policy Finder to link to additional details and access each states’ policies in their entirety. |
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Telehealth Use Among Adults with Diabetes
A recent study published in the British Medical Journal (BMJ) analyzing telehealth use among U.S. adults with diabetes highlights how this technology is reshaping care for millions of Americans. Drawing from the 2022 Health Information National Trends Survey, the research offers a snapshot of telehealth’s reach, benefits, and challenges for individuals managing diabetes.
Of the 1,116 surveyed adults with self-reported diabetes, nearly half (48.1%) reported using telehealth services in the past year. Usage patterns revealed some key demographic trends. Telehealth users were more likely to be younger, women, urban residents, and individuals with higher incomes. By contrast, adults aged 65 and older were less likely to utilize telehealth compared to those aged 18–49. Predictors of telehealth usage also included higher frequency of healthcare visits, while factors such as race, education, or rural versus urban location showed no significant differences in adoption rates. Among telehealth users, 39.3% reported using video-only services, 35.0% relied on phone-only services, and 25.7% used a combination of both. Reasons for adopting telehealth included provider recommendations, convenience, avoiding COVID-19 exposure, and guidance on in-person care needs. On the other hand, non-users cited preferences for in-person visits, concerns about privacy, and difficulties with technology as primary barriers.
Importantly, the study found that telehealth users and non-users reported similar levels of care quality, with no significant differences based on telehealth modality or geographic location. This underscores telehealth’s potential as a viable alternative to in-person visits for diabetes management. However, the study also emphasized the need for addressing barriers like privacy concerns, technology challenges, and care coordination to make telehealth more accessible. For more details, see the full study published online. |
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What’s New at CCHP this Month?
CCHP is continually working to create helpful informational content to keep those interested in telehealth and related policies up to date via our policy finder, informational factsheets, webinars, reports and email blasts. As you may already be aware, CCHP regularly distributes a single topic specific email every Tuesday titled “Telehealth Tuesdays”. If you are not yet on our distribution list to receive these emails, and would like to be added, you can do so by registering on the CCHP website.
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Quick links to recently curated and featured insightful topics in our Telehealth Tuesday email blasts:
DECEMBER 10, 2024: Deadline Approaching for Federal Medicare Waivers covering the potential impact of the expiration of the federal Medicare waivers for telehealth. Specifically highlighting the Medicare policies in place prior to COVID-19 and the implications of reverting back to that policy environment.
DECEMBER 3, 2024: 2024 In Review: State Telehealth Policy covering CCHP’s release of our annual roundup of state telehealth legislation. This year, state legislatures continued to refine, expand, and impose new standards on telehealth, responding to evolving needs in healthcare delivery and leveraging lessons learned from the COVID-19 pandemic. Notably, increasingly specific requirements for various telehealth modalities, including remote patient monitoring and audio-only services, demonstrate states’ efforts to ensure telehealth remains accessible and aligns with high standards of care.
NOVEMBER 26, 2024: Recent CCHP Resources covering recent materials CCHP has released as well as federal and state telehealth policy developments.
NOVEMBER 19, 2024: CCHP’s New Telehealth Policy Summary Report, Fall 2024: Insights and State-Level Trends covering CCHP’s release of our Summary of state telehealth policy changes for 2024. Additionally, we are also making available a state summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting our key findings. As always, the most current information in CCHP’s online policy finder tool may be exported for each state into a PDF document. Note that the last review period for this report was late May through early September 2024.
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| In addition to our featured topics in CCHP’s Telehealth Tuesday emails we have also released the following valuable resources:
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