Telehealth Policies in the Post-Pandemic Era

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its proposed Physician Fee Schedule for 2025. A major component of the proposed rule is the telehealth policies, particularly given that major Medicare telehealth waivers are set to expire at the end of 2024. CMS has limited statutory authority to extend most of the telehealth polices that were expanded during the COVID-19 pandemic. That authority rests with Congress.

Unfortunately, if no congressional action is taken soon, major telehealth polices will soon return to what they were like pre-COVID-19. In other words, unless Congress acts, Medicare will no longer be reimbursing providers for certain telehealth services that enrollees got used to during the pandemic years.

To understand why this is important, let’s touch a little bit on what telehealth even is. Telehealth can be broadly defined as the use of telecommunication technologies to provide and receive clinical healthcare. Such technologies include videoconferencing, audio calls, and digital health platforms such as mobile phone apps. During the COVID-19 stay-at-home era, a good portion of the general U.S. population found telehealth services to be useful, and while utilization rates have decreased a bit in recent years, many are still depending on it as a flexible way to access healthcare services.

Naturally, telehealth was perceived to have great potential during the COVID-19 pandemic. Following stark decreases in the availability of in-person healthcare services during the pandemic, telehealth was sought to address the health disparities that were predicted to negatively affect vulnerable populations. To meet the demand in the shift towards virtual healthcare for these groups, there was widespread adoption of telehealth services and expansions in telehealth policies.

These expansions were driven by the cessation of some in-person services, which made virtual healthcare the only option for many patients.

Although the expanded federal telehealth policies during COVID technically only applied to Medicare’s provider reimbursement, much of the commercial sector copied Medicare’s approach.

However, when President Biden announced the termination of the COVID-19 Public Health Emergency (PHE) in May 2023, it also meant the end of telehealth waivers.

• Circling back to CMS and its authority on these policies, here are some of the COVID telehealth policies that the agency has proposed to continue or expand: First, CMS did not need Congress’s approval to define “telecommunication system.” CMS redefines it in the proposed rule to allow for flexible telehealth delivery methods, including audio-only options. Audio-only services – that is, telehealth services provided by phone – were only permitted for mental and behavioral health services during the pandemic. CMS is now proposing to allow audio-only care for all telehealth services.
• Second, For Rural Health Clinics and Federally Qualified Health Centers (FQHCs), CMS is proposing to continue temporary payment for non-behavioral health visits using digital platforms.

Unfortunately, though, the truth remains that some policies, like patient locations, still require congressional actions to be maintained. Currently, Medicare reimburses providers for telehealth regardless of the patient’s or provider’s location. Once these policies expire, however, patients receiving services from some providers at home are expected to be affected.  

Things looked hopeful last year when, in June, the CONNECT for Health Act of 2023 was re-introduced by a bipartisan group of 60 senators. Unfortunately, the Act hasn’t made any progress past the introduction stage. It would have expanded coverage of Medicare telehealth services and permanently allowed for COVID-19-based telehealth flexibilities, all with the expectation of improved health outcomes.

We seem to be hearing things on Capitol Hill indicating that both sides are trying to get a healthcare bill passed during the lame-duck session, and telehealth policies have certainly been a part of those discussions. But in every election year, getting something passed in the lame-duck session is not something you want to bet on.

So, what is telehealth looking like in the next year? The anticipated inaction of Congress will likely result in many telehealth policies returning to those of the pre-pandemic times. However, actions taken by agencies like CMS is allowing for some hope that we can continue to push for telehealth services to be better integrated into the healthcare system, in the long run. Let’s leave this on a positive note.