Telehealth Flexibilities Reinstated Following Government Shutdown
Legislative Action Restores Virtual Care Policies
Flexibilities for Medicare telehealth coverage have returned after Congress passed legislation to conclude the longest government shutdown in U.S. history. The stopgap funding law, signed by President Donald Trump on Wednesday, reinstates pandemic-era virtual care policies through January 30. These policies include the removal of geographic restrictions for virtual care and the allowance for all eligible Medicare providers to offer telehealth services. Additionally, the law reauthorizes the CMS’ Acute Hospital Care at Home program, which permits hundreds of hospitals nationwide to deliver inpatient-level care in patients’ homes until January 30.
Impact of the Government Shutdown on Telehealth Services
During the six-week government shutdown, telehealth providers faced uncertainty, either continuing to offer virtual care to Medicare beneficiaries without clear reimbursement guidelines or shutting down their services. Although the new legislation allows for retroactive payment for telehealth services rendered since the shutdown began in October, Kyle Zebley, senior vice president of public policy at the American Telemedicine Association, cautioned that the “clock is ticking” before these flexibilities could lapse again.
Calls for Long-Term Solutions in Telehealth Coverage
Telehealth advocates emphasize the need for certainty in virtual care coverage within Medicare. Chris Adamec, executive director of the Alliance for Connected Care, noted that “short term, and even year-to-year, extensions are no longer sustainable for a care model that is now central to how America delivers health care.” He stressed that telehealth is an integral part of care delivery and that the system must adapt accordingly.
Background on Telehealth Flexibilities
The telehealth flexibilities were initially implemented during the pandemic to maintain access to care while adhering to social distancing measures. These policies significantly broadened telehealth coverage in Medicare, which was previously limited mainly to beneficiaries in rural areas or specific facilities and services. Despite bipartisan support for these flexibilities, they have recently become entangled in funding disputes between Democrats and Republicans.
In December, a bill aimed at extending telehealth flexibilities for two years failed, leading to a temporary spending plan that only offered a six-month extension. Lawmakers missed a September deadline to extend the provisions once more due to disagreements over financial assistance for Affordable Care Act plans set to expire at year-end. The recent legislation allows the government to reopen without addressing those subsidies.
Decline in Telehealth Utilization During the Shutdown
The interruption in telehealth flexibilities resulted in reduced access to virtual care for Medicare beneficiaries during the shutdown. An analysis by the Brown University School of Public Health’s Center for Advancing Health Policy through Research revealed a 24% decline in telehealth visits during the first 17 days of October compared to the period from July to late September. Some states experienced even steeper drops, with telehealth use in Florida, Washington, Maryland, and New York falling by nearly 40% or more.
Researchers attributed this decline to uncertainty among clinicians regarding the reimbursement of virtual care visits following the government’s reopening. Christi Siedlecki, CEO of Grants Pass Clinic in Southern Oregon, mentioned that her clinic canceled telehealth appointments due to concerns about coverage. She advocates for making the flexibilities permanent, stating, “The cat is out of the bag. They can’t shove it back in. People are used to being able to get telehealth.”
Challenges for Patients and Providers
The uncertainty surrounding telehealth has also disrupted care for patients, particularly those facing challenges in accessing in-person services. Dr. Helen Kinsman Hughes, medical director of the office of telemedicine at Johns Hopkins Medicine, highlighted the importance of virtual appointments for patients recovering from conditions like strokes or seizures.
Moreover, the ongoing short-term extensions and uncertainty have created a stressful environment for providers. Hughes noted, “People are exhausted by all of the changes and the stresses of the past six years,” emphasizing that it feels unfair to continue imposing instability on a system that has garnered widespread bipartisan support.