The Future of Telehealth: Anxiously Awaiting Legislative Action
Telehealth has become a key component of care delivery models, but the future of telehealth reimbursement remains unsettled. While the Centers for Medicare & Medicaid Services (CMS) extended many of the flexibilities introduced during the COVID-19 Public Health Emergency (PHE) multiple times over the years, many of these policies are set to expire – again – at the end of the federal government’s fiscal year – September 30, 2025 – and others will expire on December 31, 2025.
Several bills are pending[1] to address the urgent pressure on Congress to act before telehealth flexibilities expire. Further, the fiscal year 2026 appropriations bill could include extensions of Medicare telehealth flexibilities. However, to date, no long-term legislation has offered a solution to make a broad range of telehealth services a permanent benefit under Medicare.
Temporary Expansions Set to Expire
Through September 30, institutional providers can continue billing for a wide range of telehealth services, including outpatient therapy, diabetes self-management training (DSMT), and medical nutrition therapy (MNT), when delivered by hospital staff remotely to patients in their homes. These flexibilities, extended under the Full-Year Continuing Appropriations and Extensions Act, 2025, have enabled hospitals and providers to maintain access to and continuity of care for patients who may face barriers to in-person visits. Whether the ability of physical therapists, occupational therapists, speech-language pathologists, audiologists, and other practitioners to practice remotely continues beyond September 30 is uncertain.
CMS has also suspended frequency limitations on subsequent inpatient visits, subsequent nursing facility visits, and critical care consultations, but only through December 31.
CMS extended the definition of “direct supervision” to include virtual presence via real-time audio/visual technology, also through December 31. This extension has allowed diagnostic testing, outpatient hospital care, and incident-to services to continue with off-site supervising physicians.
Audio-Only Services and Behavioral/Mental Telehealth
CMS permanently revised the definition of “interactive telecommunications system” to include audio-only communication for patients in their homes, provided the practitioner is capable of video, and the patient cannot or does not consent to using it. This ensures continued access for vulnerable populations, but this benefit may still be subject to future policy shifts as CMS continues to redefine the scope of certain telehealth services, as it deems appropriate.
Relatedly, while behavioral/mental telehealth services can be delivered through audio-only communication platforms, CMS has delayed the in-person visit requirement for audio-only behavioral health services only through September 30. If not extended, an in-person visit will be required within six months prior to initiating the Medicare behavioral/mental telehealth service and annually thereafter.
Takeaway: Extensions Are Likely, But May Not Be Permanent
A permanent legislative solution is long overdue – the current telehealth flexibilities have enabled expanded access to care, improved efficiency, and innovations in care delivery. We will continue to track the legislation as the September 30 deadline approaches, with the hope that no hospital will need to revert to pre-pandemic requirements that could impact staffing models, operations, and service delivery.
[1] Telehealth Modernization Act (H.R. 5081/ S. 2709); Connect for Health Act of 2025 (S. 1261/ H.R. 4206).
