After much uncertainty, Congress has extended many Medicare telehealth flexibilities through March 31, 2025, in its end-of-year appropriations bill. However, several important flexibilities, such as first-dollar coverage of telehealth services under high deductible health plans (HDHPs) and health savings accounts (HSAs), will expire on December 31, 2024.

Although the extension ensures continued access to telehealth for Medicare patients, the short duration of the extension leaves the future of telehealth for Medicare patients uncertain and creates ongoing unpredictability in reimbursement for telehealth providers. For patients, the loss of pre-deductible telehealth coverage under HDHPs will reduce access to telehealth and impact those who have avoided telehealth because of out-of-pocket expenses.

Below, we highlight the key provisions of the bill:

Flexibilities That Will Continue

• Originating Site: A patient’s home remains an eligible originating site (i.e., location of the patient) for any telehealth service, expanding beyond behavioral and mental health care services.
• Geographic Restrictions: Geographic restrictions, such as the requirement for patients to be located in rural areas, remain waived.
• Audio-Only: Audio-only communication remains a viable option for any telehealth service.
• Expanded Provider Types: Any health care provider who is eligible to bill Medicare for covered services may continue to provide and bill for telehealth services, expanding beyond the previously limited list of eligible provider types.
• In-Person Requirements: The requirement that tele-behavioral/mental health patients must have an in-person visit within six months of their initial telehealth visit and annually thereafter remains waived.
• Hospice Care: Telehealth remains a viable option for face-to-face encounters required for hospice care recertifications.
• FQHCs and Rural Health Clinics: Federally qualified health centers (FQHCs) and rural health clinics remain eligible distant sites (i.e., location of the practitioner) for telehealth services.

Flexibilities That Will Expire

• Pre-Deductible Coverage: Telehealth services will no longer qualify for first-dollar coverage under HDHPs and HSAs.
• Acute Hospital Care at Home: Hospitals will no longer receive reimbursement for acute care services provided through telehealth to patients in their homes.
• Cardiac and Pulmonary Rehabilitation: Providers will no longer receive reimbursement for cardiac and pulmonary rehabilitation services provided through telehealth to patients in their homes.

Although Congress will need to revisit the telehealth flexibilities before they expire again, certain provisions have already been made permanent and are unlikely to change. These include:

• A patient’s home as an eligible originating site for behavioral and mental health services.
• The removal of geographic restrictions for patients receiving behavioral and mental health services.
• The availability of audio-only communication for practitioners providing behavioral and mental health services.

A Brief History

Congress first implemented Medicare telehealth flexibilities during the COVID-19 PHE in 2020. The flexibilities were later extended, or made permanent in certain cases, through the 2021 Consolidated Appropriations Act (CAA), 2022 CAA, and 2023 CAA. For more details, refer to our prior discussions detailing the extensions provided in the 2022 CAA and 2023 CAA.

Make Your Voice Heard

As Congress again approaches the expiration of temporarily extended Medicare telehealth flexibilities, it will again debate whether to extend them or make them permanent. Congress may also consider whether to retroactively extend the flexibilities set to expire at the end of 2024. Telehealth has always been a bipartisan issue, and stakeholders are encouraged to contact their local Congressperson and the incoming Trump administration to advocate for continued access.