Congress recently passed a limited extension of certain flexibilities relating to Medicare coverage of telemedicine. While the current extension is a stop-gap measure that expires March 31, 2025, it may signal Congressional acknowledgement of the importance of these flexibilities to healthcare providers and patients across the country and an intent to eventually make them permanent.
Prior to the COVID-19 Public Health Emergency (PHE), Medicare coverage of services provided by telemedicine was very limited. Two of the most important limitations related to the “originating site” of the telemedicine service, that is, where the patient is while receiving the service via telemedicine. Specifically, Medicare would only cover telemedicine services where the originating site (1) was located in specified rural area and (2) was a specified clinical setting, such as a physician’s office or other facility. These rules generally precluded the use of telemedicine in urban or suburban areas and precluded nearly all patients from receiving telemedicine services in their homes.
During the COVID-19 PHE, the Centers for Medicare & Medicaid Services (CMS) waived these requirements and allowed telemedicine services in more settings, including in patients’ homes and in more than just rural areas. When the PHE ended, so too did CMS’ authority to continue these regulatory flexibilities. However, by that point, telemedicine services had become widespread and providers and patients acknowledged that it had a valuable role to play in the delivery of healthcare services. Therefore, Congress by statute extended these flexibilities past the end of the PHE, but included an expiration date of December 31, 2024.
By creating an expiration date in federal law, Congress created a problem that only Congress could fix. As the December 31, 2024 expiration date loomed, Congress scrambled to extend these flexibilities in the year-end appropriations bill. A proposed version of the bill would have extended these flexibilities until the end of 2026. However, this proposal was the version of the bill that was rejected by President-elect Trump on the basis that it was far too long and contained far too much federal spending. When a significantly pared-down version of the billed was passed and signed into law (188 HR 10545), it included an extension of these telemedicine flexibilities only until March 31, 2025.
Currently, these telemedicine flexibilities will expire March 31, 2025, which would have a significant impact on Medicare coverage of telemedicine services and on providers that rely on this coverage. While Congress may yet extend them further or possibly make them permanent, providers should be aware of the possibility that it may not, should closely watch this area of Medicare regulation, and have a plan in the event that these flexibilities are not extended.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to Medicare coverage of telemedicine services or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com