Telehealth flexibilities have expired. Here's what you need to know.

WHAT THE EXPIRATION OF FLEXIBILITIES MEANS FOR STAKEHOLDERS

In a recent blog, the National Consortium of Telehealth Resource Centers outlined the impact of allowing the flexibilities to expire.

First, healthcare providers will no longer be reimbursed for telehealth visits delivered to Medicare beneficiaries in their homes in most cases, as geographic restrictions on originating sites for telehealth services have been reinstated. Further, federally qualified health centers (FQHCs) and rural health clinics (RHCs) will no longer be able to serve as distant site providers for most telehealth services after December 2025.

Additionally, occupational therapists, physical therapists, speech-language pathologists and audiologists are no longer eligible to provide telehealth services to Medicare beneficiaries, and audio-only telehealth will no longer be broadly covered, except when the patient is in their home and the distant site provider can use live video, but the patient cannot or does not want to use it.

The Medical Group Management Association (MGMA) noted that CMS has directed Medicare Administrative Contractors (MACs), which process claims for Medicare fee-for-service payments, to hold claims for 10 business days. This action aims to avoid the need for reprocessing large volumes of claims if Congress acts.

The American Psychiatric Association (APA) detailed the impact of the flexibilities expiring on telebehavioral healthcare, which is extremely popular among providers and patients alike.

Starting Oct. 1, 2025, patients must have had an in-person mental health visit with their provider or a provider from the same specialty from their group within the previous six months to participate in telehealth, and then at least annually thereafter. There are two exceptions to the six-month in-person visit rule: patients who already receive telebehavioral health services and have circumstances where in-person care may not be appropriate, then groups with limited availability for in-person behavioral health visits. The latter have the "flexibility to arrange for practitioners to provide in-person and telehealth visits with different practitioners," the APA stated.

The 419 healthcare facilities approved for the AHCAH waiver as of Sept. 22, 2025, will face major disruptions to their hospital-at-home (HaH) programs. CMS stated that all HaH program patients must be discharged or returned to the hospital on Sept. 30, 2025, if the waiver is not extended. Further, the agency stopped accepting waiver applications after Sept. 1, 2025.

Although HaH leaders have been preparing for this eventuality, they previously noted the capacity management challenges it would create for facilities across the country.

TELEHEALTH FLEXIBILITIES STILL IN PLACE

However, not all telehealth flexibilities enacted during the COVID-19 PHE are impacted by the expiration.

Telehealth.org, a resource for telehealth leaders acquired by Doxy.me in 2024, noted that first-dollar telehealth coverage was made permanent for individuals with a high-deductible health plan (HDHP) that utilizes a Health Savings Account (HSA) under the One Big Beautiful Bill Act. This allows Americans with HDHP-HSAs to access telehealth services without needing to meet their deductible first.

Further, there is a plan for managing telehealth prescribing of controlled substances after a pandemic-era flexibility expires on Dec. 31, 2025. The flexibility allows telehealth prescribing of controlled substances -- including Schedule II controlled substances like Adderall and Oxycodone -- without a prior in-person exam.

In a proposed rule released in January, the DEA described three types of registrations that would allow healthcare practitioners to continue prescribing controlled substances via telehealth after Dec. 31, 2025. However, the proposal was met with pushback from the industry, with leaders voicing concerns about the added administrative burden of the special registrations framework.

INDUSTRY REACTIONS TO THE EXPIRATION

For months, telehealth and industry groups have urged Congress to make permanent or extend telehealth and HaH flexibilities. Leaders were hopeful earlier this year, telling Virtual Healthcare that they expected another three-month extension at the very least.

While continuing resolution legislation, passed by the House on Sept. 19, would have extended the virtual care flexibilities through Nov. 21, the Senate failed to adopt it.

Prominent medical associations are highlighting the adverse impact of the expiration of flexibilities in letters to President Donald Trump and congressional leaders.

"This lapse of telehealth waivers is sowing significant confusion and forcing medical groups to make difficult decisions about rescheduling appointments, transitioning from telehealth to in-patient care, or potentially providing telehealth treatment to Medicare beneficiaries during this lapse in funding even though it may not be reimbursed," wrote Anders M. Gilberg, senior vice president of government affairs at MGMA, in an Oct. 2, 2025, letter.

Kyle Zebley, senior vice president of public policy at the American Telemedicine Association (ATA) and executive director of its advocacy arm, ATA Action, echoed Gilberg, stating on Oct. 1, 2025.

"Most providers and hospital systems are taking calculated risks to continue care during this time, but long-term continuity depends on action by our telehealth champions in Washington to restore these flexibilities and ensure retroactive reimbursement," Zebley stated. "Medicare patients woke up this morning without telehealth coverage for the first time since the pandemic, five years ago. Our healthcare services are regressing, falling woefully short for millions of patients in need."

Both organizations are asking federal leaders to reinstate the virtual care flexibilities and enact a retroactive telehealth reimbursement provision.

Digital health companies and providers are also voicing their concerns.

"Congress has failed to answer the question of long-term Hospital-at-Home reimbursement, and instead has cast further doubts on the program," said Jiang Li, CEO of remote patient monitoring solution Vivalink, in an emailed statement,  Health systems are seeking clarity before making the financial commitment to launch these innovative at-home care programs, and further delay of a more permanent solution is causing U.S. hospitals to lag behind some of the other developed nations in terms of quality and delivery of care."

WHAT'S NEXT

While the healthcare industry awaits congressional action, stakeholders can take some steps to mitigate the ongoing challenges.

First, providers can consider issuing an Advance Beneficiary Notice of Noncoverage when delivering telehealth services that Medicare may no longer cover. A note from the Foley & Lardner law firm stated that CMS is reminding providers of this notice.

Telehealth proponents can also get involved in advocacy efforts through various healthcare trade organizations, including ATA Action.

Several pieces of legislation have been introduced in the House and Senate this year that include provisions to extend or make permanent virtual care flexibilities. These include the Telehealth Modernization Act, the Telehealth Coverage Act and the CONNECT for Health Act.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.