As 2024 comes to a close, the telehealth space continues to be uncharted territory. When the COVID-19 pandemic began, the ability to deliver telehealth expanded as providers sought to provide quality care unrestricted by physical, in-person requirements. Now, the issue has shifted to the other side of the telemedicine coin: Following this rapid expansion, facilitated by a plethora of telemedicine flexibilities set forth in state and federal law, is Congress ready to pass laws that make these flexibilities permanent? Without any congressional action, the telehealth world is set to revert back to a pre-COVID-19 framework on January 1, 2025, where specifically for Medicare patients, with few exceptions including some for rural areas, patients can no longer receive telehealth in their homes.

The Medicare telehealth framework was expanded by a patchwork of legislation passed between March 2020 and December 2023. The expansions impact the core of Medicare’s coverage eligibility and reimbursement requirements for telehealth. As a result, healthcare providers continue to call for action to bridge the gap from flexibilities back to original telehealth boundaries in order to avoid a telehealth cliff that could impact the continuity of care to Medicare patients.

The following list includes key expansions set to expire on December 31, 2024:

1. Originating Site. Prior to COVID-19 flexibilities, the term “originating site” remained confined to (a) sites enumerated by law that are (b) located in a certain geographic location. The term “originating site” was expanded to mean “any site in the United States at which the eligible telehealth individual is located at the time the service is furnished… including the home of an individual.”. The flexibilities also allow all services to be provided in an individual’s home, where without flexibilities, only a few services may be provided in the home.
2. Provision of Services. The flexibilities have allowed additional kinds of services to be provided via telehealth, for example, physical and occupational therapy services and certain emergency department services.
3. Technology for Services. Further, flexibilities allowed broader means to access care by allowing certain services to be delivered via audio-only encounters. Prior to the flexibilities, and beginning in the new year, reimbursement for telehealth services will generally require the use of technology permitting audio and video to deliver two-way, real-time interactive communication.
4. Service Providers. COVID-19 flexibilities expanded the definition of telehealth practitioners to include occupational therapists, physical therapists, speech-language pathologists and audiologists.
5. Behavioral Health In-Person Requirements. Prior to COVID-19, Medicare regulations required a beneficiary receive at least one in-person mental health visit at least every 12 months while receiving services furnished via telehealth for diagnosis, evaluation or treatment of mental health disorders. The flexibilities lifted this in-person requirement to receive behavioral telehealth services until January 1, 2025.

Beginning January 1, 2025, the provision of telehealth to Medicare patients may look different than the “telehealth” patients have become familiar with during the COVID-19 pandemic without Congressional action. Some bills have been proposed to renew these extensions but, to date, have not progressed to the voting stage in either chamber. CMS recently published the Provider Fee Schedule of 2025 acknowledging this “cliff,” but that it is limited in its regulatory power and cannot otherwise unilaterally expand when and how telehealth can be provided.

Thus, providers should continue to monitor the telehealth legislative landscape and move towards the end of the year aware that certain telehealth flexibilities could finally come to an end.