Spring 2025 Issue

HIM Challenges: Congress Hits Pause on Sunsetting Telehealth Flexibilities
By Elizabeth S. Goar
For The Record
Vol. 37 No. 2 P. 6

Telehealth proponents breathed a sigh of relief on March 15, 2025, when the pandemic-era flexibilities that greatly expanded telehealth access were extended through September as part of the continuing resolution preventing a federal government shutdown. However, the reprieve is only temporary, and continuing the battle to preserve telehealth access is one that advocates say is worth fighting to protect what many now consider a foundational aspect of health care.

“Telehealth is a lifeline for millions, ensuring patients receive the care they need. If Congress failed to extend these latest flexibilities—and does not urgently find a permanent solution—millions of patients could lose access to virtual care they rely on to manage their health,” says Julia Mirich, spokesperson for Telehealth Access for America (TAFA), adding that the rapid expansion of telehealth motivated in part by the pandemic-era provisions are behind new investments in technology and service offerings.

“Medicare telehealth flexibilities serve as a catalyst for innovations that have improved our ability to manage chronic illnesses, remotely monitor patients, lower health care costs, and more,” she adds. “Long-term uncertainty and the repeated prospect of a telehealth cliff undermine the full potential of virtual care to improve health outcomes and strengthen the US health care system.”

The Road to Popularity
Telehealth made its first legislative appearance in the Balanced Budget Act of 1997, which mandated Medicare reimbursement for some services and funded demonstration projects to determine its efficacy. However, it wasn’t until the COVID-19 pandemic that telehealth gained real traction, with its popularity soaring after CMS relaxed telehealth rules as part of its 2020 response to the public health emergency.

Along with removing site restrictions, CMS expanded the list of qualifying providers, permitted audio-only evaluation and management visits, and allowed providers to conduct telehealth visits from their homes without updating their billing addresses. Medicare also began reimbursing for telehealth services at the same rate as in-office visits. The Coronavirus Aid, Relief, and Economic Security Act also permitted high-deductible health plans (HDHPs) to cover telehealth services before patients met their deductibles without jeopardizing Health Savings Account (HSA) eligibility.

The result was a surge in telehealth adoption. Health and Human Services (HHS) reports that the percentage of Medicare telehealth visits surged from under 1% in 2019 to more than 43% in April 2020—a 63-fold increase in utilization.1 By 2023, nearly 87% of hospitals and 6 million Medicare patients were using telehealth.2

Telehealth flexibilities were extended several times postpandemic, most recently via the American Relief Act of 2025. Passed on December 20, 2024, the act averted a government shutdown and extended telehealth waivers through March 31, 2025.

“Telehealth is not a fad. It is here to stay so long as Congress makes these flexibilities permanent,” Mirich says. “Since TAFA launched in 2021, our membership has more than doubled and includes dozens of patient advocacy organizations supporting telehealth and these flexibilities. This is due to the broad-based support from across the entire health care spectrum for telehealth protections, especially from the patient community.”

Calls for Permanency
The inclusion of telehealth flexibilities in the March 2025 continuing resolution was “a big victory for telehealth, and a huge relief for patients and clinicians in every state and region of the United States, especially those in underserved communities,” said Kyle Zebley, executive director of ATA Action, in a release following passage of the legislation. “By including these provisions in this stopgap legislation, Congress sent a very clear message that telehealth is a fundamental part of care delivery, and that we must not reverse the significant progress made in modernizing our health care system.”3

Receiving a temporary reprieve was the Medicare Telehealth Flexibilities policy, which enables telehealth visits from a wider range of locations, including the patient’s home, and allows additional qualified provider types to deliver virtual care. Also extended was the Acute Hospital Care at Home Program, which allows Medicare-certified hospitals to furnish inpatient-level care in patients’ homes.

“These flexibilities have been crucial in increasing access to virtual care for millions of patients, especially our nation’s seniors. These Medicare waivers remove previous geographic and originating site of care restrictions, ensure access to audio-only services, and expand the list of providers and types of care available virtually,” Mirich says.

It wasn’t a total victory, however. Among the provisions not spared are first-dollar HDHP-HSA coverage, telehealth as an excepted benefit, an expanded Medicare Diabetes Prevention Program featuring telehealth components, and expanded in-home cardiopulmonary rehabilitation services.

The temporary nature of this latest extension, which expires September 30, 2025, is another hurdle facing advocates who have been fighting for telehealth’s permanency for years. In its press release, ATA Action pledged to “double down on our efforts to stop this telehealth rollercoaster and restore certainty and confidence for patients and clinicians, to know that our health care system will not let them down when they need it most.”

TAFA, meanwhile, “calls on Congress to make these flexibilities permanent once and for all, rather than continue to punt on the issue, to ensure patients and providers have the certainty they need without the continued risk of a telehealth cliff resurfacing around every government funding deadline,” Mirich says.

Mark Schoeberl, executive vice president of advocacy for the American Heart Association, calls telehealth “critical for America’s heart health,” noting that millions now rely on virtual care to manage their conditions. For example, telehealth provides increased access to remote patient monitoring, which can help quickly recognize and support a swift response to certain heart conditions and to life-saving access to treatments and specialists, such as telestroke services.

“It is long past time for Congress to enact a permanent solution that safeguards Medicare telehealth flexibilities and the patients and providers who benefit from them,” he says.

Looking Ahead
Although telehealth policy holds few certainties, its potential appears encouraging. During his Senate confirmation hearing, CMS Administrator Mehmet Oz, MD, emphasized that telehealth would be a key priority, stating that “Congress has a responsibility to extend telehealth widely throughout the nation, as it was during COVID.”

Telehealth, he said, “is a major focus of mine, and if confirmed, it’s one of the areas I think we’ll be able to make major inroads, because there are no opponents to this.”4

Mirich notes that these Medicare telehealth flexibilities were initially enacted by Congress during the first Trump Administration. Further, HHS Secretary Robert F. Kennedy, Jr affirmed his support for virtual care during his confirmation hearings.

“We encourage the administration and Congress to work together to permanently extend current Medicare telehealth flexibilities,” Mirich says. “More than 6 million Medicare beneficiaries utilized virtual care in 2023 and continue to benefit from the increased access to care, lower costs, and health and quality of life improvements telehealth offers. Increased access to telehealth is also supported by providers, like physicians, who cite reduced burnout and expanded access to high-quality care as just a few benefits.

“There is broad bipartisan support on this issue,” she says. “Congress must utilize this momentum to urgently and permanently protect virtual care.”

— Elizabeth S. Goar is a freelance health care writer in Wisconsin.

 

References
1. Office of the Assistant Secretary for Planning and Evaluation. Medicare beneficiaries' use of telehealth services: a brief. https://aspe.hhs.gov/sites/default/files/migrated_legacy_files/198331/hp-issue-brief-medicare-telehealth.pdf. Published December 2021.

2. Fact sheet: telehealth. American Hospital Association website. https://www.aha.org/fact-sheets/2025-02-07-fact-sheet-telehealth. Published February 7, 2025.

3. No shutdown for telehealth as Congress passes spending bill to keep the government open, including critical telehealth extensions: ATA action celebrates vote. American Telemedicine Association website. https://www.americantelemed.org/press-releases/no-shutdown-for-telehealth-as-congress-passes-spending-bill-to-keep-the-government-open-including-critical-telehealth-extensions-ata-action-celebrates-vote/. Published March 15, 2025.

4. CMS director nominee Dr. Oz touts chronic disease care, telehealth during confirmation hearing. Hospice News website. https://hospicenews.com/2025/03/14/cms-director-nominee-dr-oz-touts-chronic-disease-care-telehealth-during-confirmation-hearing/. Published March 14, 2025.