Sitting Atop a Telehealth Cliff?

Once again, Congress is quickly approaching a telehealth cliff.

Without passing additional legislation, current Medicare telehealth flexibilities will expire on March 31, 2025. If this happens, millions of beneficiaries who have used telehealth as a means for receiving needed and often critical health care services, especially since 2020, will lose coverage for this benefit starting on April 1, 2025. This will mean, with limited exceptions, that Medicare beneficiaries will have to travel to a health care provider’s office or a health care facility to receive most telehealth services.

What Medicare Beneficiaries Have Come to Rely Upon

The COVID-19 pandemic changed perceptions of telehealth for many Americans. Starting in March 2020, Congress eased restrictions for Medicare beneficiaries as many health care providers closed offices and patients worried about being exposed to the virus in traditional in-person health care settings. Telehealth, and the greater access that the Medicare flexibilities allowed beneficiaries to have, was enormously appealing to patients living in rural areas or with mobility problems. Between April 2020 and June 2020, nearly half of all Medicare beneficiaries had at least one virtual medical visit.

Fast forward to May 2023, when the COVID-19 public health emergency officially came to an end. Congress folded extensions of the Medicare telehealth flexibilities into various spending bills, including a bill passed in December 2024. The difference? Unlike the other extensions, the bill (the American Relief Act, 2025 or “Act”) only created a 90-day extension for the Medicare telehealth flexibilities, through the end of March 2025. Section 3207 of the Act outlines what the continued flexibilities currently are:

• Lifting geographic restrictions and maintaining the expanded list of originating sites including patients' homes.
• Expanding the list of distant site practitioners to include all practitioners who are eligible to bill Medicare for covered services (e.g., physical therapists, occupational therapists, speech-language pathologists, audiologists, marriage and family therapists, and mental health counselors).
• Allowing federally qualified health centers and rural health clinics to serve as distant site providers of telehealth services.
• Allowing payment for audio-only telehealth services.
• Extending the waiver of the requirement for practitioners who provide behavioral and mental health via telehealth to provide in-person visits within 6 months of the first telehealth visit and annually thereafter.
• Extending Acute Care Hospital at Home waiver authorities.

Medicare beneficiaries can receive the telehealth services described above through March 31, 2025.

What Happens Next?

With the March 31st deadline fast approaching, key organizations like the American Telemedicine Association (ATA) are working overtime to raise awareness of the pending deadline and ensuring telehealth remains accessible and viable for both patients and providers. In a recent letter to policymakers, ATA urged Congress to act decisively before the looming deadline. The ATA’s letter focused on the following priorities:

• Making Medicare telehealth flexibilities permanent—removing geographic restrictions limiting telehealth to rural areas, ensuring FQHCs and RHCs can continue offering virtual care, and guaranteeing fair reimbursement rates for all providers.
• Preserving audio-only telehealth options—for many telehealth users, especially seniors and those living in locations without reliable broadband access, phone calls are the only way to connect patients to providers in order to receive care via telehealth. Losing this flexibility will disproportionately affect vulnerable patients.
• Rolling back restrictive Drug Enforcement Administration regulations—removing in-person visit requirements for prescribing controlled substances via telehealth. This has been a subject of other recent Health Law Advisor posts.

Epstein Becker Green will be closely following all relevant legislative developments. For additional information about the issues discussed above, or if you have other telehealth-related questions or concerns, please contact the Epstein Becker Green attorney who regularly handles your legal matters, or one of the authors of this blog post. Read more about our expansive capabilities and offerings here.