WASHINGTON—Waivers that provided key telehealth flexibilities expired Sept. 30 as the U.S. Congress hit an impasse over budget bills and triggered a government shutdown.
Telehealth may still be provided but reimbursement is uncertain. Some providers are continuing services while others have stopped scheduling virtual visits, the American Telehealth Association said. ATA Action, an offset organization of the American Telehealth Association (ATA), urged President Donald Trump in a letter to reinstate the telehealth flexibilities and the Acute Hospital Care at Home Program and to enact a retroactive telehealth reimbursement provision, ensuring that providers and hospital systems are compensated for telehealth services delivered during the government shutdown period.
In the letter, ATA Action listed several of the consequences and challenges that will arise for those in the telehealth industry including:
- Some providers and systems are continuing telehealth services in hopes that a retroactive reimbursement provision will be enacted, recognizing that critical care outweighs the risk.
- Others are prioritizing patient care immediately while preparing for additional operational or financial actions if the shutdown continues.
- In inpatient settings, some hospitals are absorbing costs.
- Some providers and hospital systems are already blocking the ability for beneficiaries to schedule virtual visits.
- Small clinics are continuing to see patients while monitoring the evolving situation, but they cannot sustain this model without certainty; prolonged uncertainty may lead to significant financial strain and, in some cases, force closures.
- Providers are communicating to patients that they may be responsible for fronting costs if CMS reimbursement is delayed.
- Compliance teams are actively reviewing claims through the ABN process, ensuring that all regulatory and procedural requirements are met despite the uncertainty.
In two separate letters, ATA Action urged both President Trump and Congress to start the work towards resolving the shutdown and placing important matters like the telehealth waiver back on the table.
"The examples collectively demonstrate that most providers and hospital systems are taking calculated risks to continue care, but long-term continuity depends on Congressional action to restore telehealth flexibilities and ensure retroactive reimbursement,” ATA Action Executive Director Kyle Zebley wrote in the letter. “ATA Action asks Congress and the Administration to consider any existing regulatory or executive authorities to maintain care continuity while awaiting formal Congressional action."
At the outset of the COVID-19 pandemic, the federal government ensured hospitals and health systems were able to leverage telehealth services to respond to the influx of unprecedented needs. These actions included the Centers for Medicare & Medicaid Services (CMS) waiving certain regulatory requirements and Congress providing legislative support to ensure hospitals and health systems could quickly deploy virtual services.
Telehealth shutdowns have been an issue throughout the past year as organizations and politicians have worked to extend the waivers which were set to expire without Congressional action on Sept. 30. In August, ATA Action released a co-led letter to Congressional leadership signed by more than 350 stakeholder organizations, urging both the House and Senate to act swiftly to make Medicare telehealth flexibilities permanent, or to approve the longest possible extension. In September, United States Sens. Tim Scott (R-SC) and Brian Schatz (D-HI) reintroduced the Telehealth Modernization Act, a bill that would extend telehealth access for Americans enrolled in Medicare through fiscal year 2027.