Following the release of Congress’ end-of-year continuing resolution package unveiled on December 17, President-elect Donald Trump on December 18 made clear his opposition, according to news coverage, a move that places the key aging services policy and LeadingAge priority wins at risk — including telehealth extensions.

We want to be sure that members know they need to take action and change policies and procedures if the Medicare fee for service telehealth flexibilities are not extended by December 31^st, 2024.

Under the framework that has been in place since March of 2020, telehealth is currently available to Medicare beneficiaries in both urban and rural areas, and patients can receive telehealth services from any location, including their home as the “originating site.” Prior to the expansion, telehealth coverage in traditional Medicare was limited to rural areas (with certain exceptions), and patients were required to travel to an approved originating site, such as a clinic, a nursing home, or doctor’s office, when receiving telehealth services.

• If Congress does not pass legislation that extends the current waivers, providers who are providing Part B telehealth services will not be able to bill for services provided in the home via telehealth.
  • Example: If your organization offers palliative care and has been billing Part B for telehealth visits to patients who are in their homes at the time of the visit, these services will no longer be billable under Medicare Part B starting Jan 1, 2025 if no action is taken by Congress because the home will no longer be an originating site.
• Additionally, the geographic restrictions will be reinstated so even if you are an eligible originating site – like a nursing home – your nursing home would have to meet the geographic restrictions to be an originating site for billing telehealth services.
• The hospice face to face recertification can be conducted via telehealth until Dec 31, 2024. If Congress does not act to extend the policy, then starting on Jan 1, 2025, all face to face recertifications must take place in person.

• Until Dec 31, 2024, physical therapists, speech language pathologists, occupational therapists, and audiologists can bill Medicare for telehealth services. If Congress does not take action, these classes of providers will not be able to bill Medicare for telehealth services even if they practice in an eligible geography and otherwise meet the requirements for telehealth billing.
• Audio-only telehealth billing will end without action from Congress.
• Caveats
  • Behavioral and mental health providers will still be able to bill Medicare for patients receiving behavioral/mental health care in their home
  • There are no geographic restrictions for originating site for behavioral/mental telehealth services
  • Behavioral/mental telehealth services can be delivered using audio-only communication platforms
  • Medicare Advantage plans and some accountable care organizations (ACOS) have different rules around telehealth provision.

Start updating your policies and procedures and educating your staff that telehealth rules may change. We will still advocate for telehealth extenders and they still may happen but providers need to be prepared either way.

Follow the negotiations via our Updates: Year-End Funding and Policy Negotiations; Agency Contingency Plans serial post.