Medicare telehealth deadline sparks healthcare providers’ anxiety

The telehealth expansion introduced during the pandemic is set to end on March 31, creating significant uncertainty for healthcare providers and patients.

Initially established as an emergency response in March 2020, Medicare’s telehealth coverage has since become a crucial component of modern healthcare.

The federal health insurance program’s policies provided essential support for routine check-ups, mental health care, and chronic disease management. However, their temporary nature now threatens their continuation beyond March 31, 2025.

As such, Medicare patients and providers face uncertainty while they await a decision on whether telehealth flexibilities will be extended, made permanent, or scaled back.

Bruce A. Scott, MD, president of the American Medical Association (AMA), said, “Congressional action is required to prevent the severe limitations on telehealth that existed before the COVID-19 pandemic from being restored.”

In any case, Medicare’s current telehealth coverage remains complex and inconsistent. While some services have been permanently expanded, others are nearing expiration.

Additionally, unresolved state licensure requirements continue to complicate cross-state telehealth practices, creating further challenges for providers and patients alike.

Telemedicine’s political rollercoaster

The extension of Medicare’s telehealth flexibilities has been marked by shifting political support and unpredictable legislative decisions.

Initially, bipartisan backing seemed secure. Then, almost overnight, that certainty unraveled. Political maneuvering led to unexpected opposition from figures such as President-elect Donald Trump and Elon Musk, resulting in a scaled-back extension that now only lasts until March 31, 2025.

These rapid regulatory changes have created challenges for medical practitioners, as Marika Miller, a telehealth and health care regulatory lawyer of Foley & Lardner LLP noted. Many providers had structured their budgets and infrastructure based on the expectation that Medicare’s telehealth coverage would remain stable through 2025.

With uncertainty looming, concerns are mounting over whether private insurers will follow the  federal health insurance program’s lead in rolling back coverage.

“The assumption had been that telehealth was an established part of the healthcare system. Suddenly, it was a question mark,” observes Miller.

While temporary extensions have provided some relief, they have also introduced significant unpredictability, making it difficult for providers to plan effectively.

Telemedicine regulations: what’s gone and what stays

Despite recent setbacks, telehealth remains a vital option for many patients.

Medicare continues to cover services like remote mental health visits, ensuring patients can access care from home without geographic restrictions. Audio-only telehealth visits also remain covered, providing a crucial link for those with limited internet access.

However, two key flexibilities have already ended. High-deductible health plans (HDHPs) tied to Health Savings Accounts (HSAs) no longer cover telehealth services until patients meet their deductibles, increasing potential out-of-pocket costs.

Additionally, Medicare has ceased coverage for cardiac and pulmonary rehab via telehealth, forcing many individuals with heart or lung conditions to return to in-person care.

These changes are particularly concerning for patients with chronic illnesses or mobility challenges.

Telehealth usage among physicians saw a staggering increase from 14% in 2016 to nearly 80% in 2022, an AMA survey revealed, underscoring its widespread adoption and necessity.

Today, over half of U.S. hospitals offer telehealth services via video, and nearly every state Medicaid program includes some form of coverage.

Despite this progress, many providers fear the consequences if Medicare does not extend its telehealth flexibilities beyond March 31.

The call to action

As the deadline approaches, key organizations such as the American Telemedicine Association (ATA) and the AMA are intensifying their advocacy efforts.

These groups are urging Congress to take decisive action before it’s too late, emphasizing several urgent priorities.

A significant focus is removing geographic barriers restricting telehealth services to rural areas, ensuring fair compensation for all providers, and preserving operational flexibility for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

The ATA’s executive director, Kyle Zebly, emphasized in a recent letter to Congress, “We urge you to make the Medicare telehealth flexibilities permanent or extend them for as long as possible.”

Additionally, the AMA is backing bipartisan legislation. The effort, led by Reps. David Schweikert, a Republican from Arizona, and Mike Thompson, a Democrat from California, aims to permanently establish Medicare’s current telehealth policies through legislation.

These efforts highlight the growing recognition of telemedicine’s pivotal role in modern healthcare delivery.

Dr. Mehta also emphasizes the need for medical providers to take an active role in this effort.

“Physicians need to be vocal about how telehealth has improved patient access and their own ability to provide quality care,” she stated.

Digital health regulations in the USA

The push for extended or permanent Medicare telehealth coverage is closely tied to broader regulatory compliance challenges.

Telemedicine regulations vary widely across states, creating hurdles for cross-border healthcare delivery. Efforts to establish national licensure agreements have been slow-moving, forcing providers to navigate a fragmented system of state-by-state licensing requirements.

Another significant challenge lies in aligning drug enforcement policies with telemedicine practices. DEA rules frequently impose unnecessary obstacles for doctors prescribing controlled medications via telehealth, particularly for individuals managing chronic pain or addiction.

“During the pandemic, these barriers were lifted temporarily, but they’re creeping back,” Dr. Mehta noted.

As a result, patients who travel often or have relocated are finding it increasingly difficult to maintain consistent care.

Advocates argue that rolling back these restrictive measures is essential to maintaining continuity of care and ensuring patients have access to necessary medications. The push for regulatory reform in this area is gaining momentum as more policymakers acknowledge the critical role of telemedicine in modern healthcare.

The challenge highlights the need for a comprehensive telehealth policy that improves access and regulatory alignment at all levels.

The broader impact on healthcare systems

Beyond the direct impact on patients, potential rollbacks in Medicare’s telehealth coverage could have far-reaching implications for healthcare systems across the country.

Many health systems have integrated telemedicine into their operational models, leveraging it to improve patient access and reduce costs.

“Telehealth has become a critical part of how many of us care for patients. If these policies are rolled back, it would have a huge impact on patient access and our ability to deliver care efficiently,” explains Dr. Mehta.

Medical professionals have dedicated some days exclusively to online visits and keep face-to-face meetings available only for complex cases.

By prioritizing virtual visits for routine check-ups and reserving in-person appointments for more complex cases, this strategy not only decreases the time patients spend waiting but also guarantees that individuals needing face-to-face medical attention can access it without delay, thus improving the seamless flow of health services.

Conclusion

Healthcare providers are now facing significant challenges due to the uncertain future of telehealth funding, which is causing widespread disruption and unease in systems that have integrated these services deeply into their daily operations.

There is considerable concern that Medicare’s actions regarding telehealth services might set a precedent for private insurers, who often model their own policies after the federal insurance program.

This alignment could result in widespread policy changes affecting numerous health insurance providers and ultimately impacting patient access to telemedicine across different healthcare sectors.

Securing the future of telemedicine relies not only on immediate legislative interventions but also on the implementation of extensive regulatory reforms and the development of supportive policies.

These measures are essential to sustaining telemedicine’s growth and ensuring that all patients continue to have access to remote health services.