The 'Big Beautiful Bill' Was a Big Beautiful Bust for Telehealth, and Now the Clock Is Ticking

While President Trump's reconciliation package did reinstate first-dollar coverage for HDHP-HSAs, a collection of waivers aimed at boosting coverage for and use of telehealth didn't make the cut.

Healthcare leaders hoping for good news in President Trump's so-called "Big, Beautiful Bill" were largely disappointed at the outcome. But supporters are saying the fight to extend or even make permanent pandemic-era waivers isn't over yet.

The reconciliation package, approved by Congress on July 3 and signed by Trump on the 4^th, makes no mention of most of the waivers, which were put in place during the COVID-19 pandemic to boost coverage for and use of telehealth. Those flexibilities include:

• Waiving geographic restrictions on telehealth coverage and use;
• Expanding the list of providers able to bill Medicare for telehealth services;
• Allowing audio-only telehealth services;
• Easing originating site restrictions on telehealth so that the patient can receive treatment at home;
• Waiving the in-person requirement for telemental health treatment;
• Enabling telehealth service for hospice care; and
• Enabling Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to use telehealth.
• Extending the CMS Acute Hospital care at Home (AHCaH) program, which enables Medicare reimbursements for close to 400 health systems and hospitals following the CMS guidelines.

With those waivers in place, many health systems and hospitals expanded their telehealth platforms during the pandemic and have continued with an aggressive virtual care strategy since then. Should those waivers end, the fear is that telehealth programs across the country will scale back or even be discontinued, hindering access to care for millions of Americans.

One flexibility, however, was included in the "One Big Beautiful Bill Act" (OBBBA): first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts (HDHP-HSAs). That provision had actually been left out of earlier bills but was brought back into the limelight with the OBBBA.

"This legislation will give millions of American workers permanent access to coverage of telehealth services without jeopardizing their HSA eligibility," Kyle Zebley, senior vice predicant of public policy for the American Telemedicine Association and executive director of the organization's ATA Action lobbying arm, said in a press release. "We could not be more pleased and proud of our Congressional policy champions for their steadfast commitment to virtual care, especially amidst significant deliberations and concessions made in order to pass a final bill before the July 4 deadline."

"Telehealth stands out as a bright spot in the final reconciliation package – a policy unicorn –  achieving unwavering support from both sides of the isle, in both chambers," Zebley said. "We believe this bodes well for the future of other critical telehealth policies requiring Congressional action. While many of the provisions in final ‘big beautiful bill' now … will create challenges for our healthcare system and the Medicare population, inclusion of this permanent telehealth provision clearly demonstrates the relentless bipartisan, bicameral support that telehealth has experienced over the past five years."

Left unsaid was why that one flexibility was included in the 1,000-plus-page bill but none of the others were, leaving those waivers to expire at the end of September.

Some believe the proposed CMS 2026 Physician Fee Schedule, introduced on July 14, was an attempt to continue momentum for telehealth and digital health that the OBBBA might have blunted. The proposed PFS includes several positive steps, including new billing codes and relaxed requirements for remote patient monitoring (RPM), support for digital therapeutics and a long-sought update to the Medicare Diabetes Prevention Program that would pave the way for virtual care delivery.

Still, the spotlight now is squarely on those telehealth waivers, especially for healthcare executives trying to plan out their virtual care strategies. With margins tight and revenues declining, it will be hard to make up for the lost Medicare reimbursements.

In an e-mail to HealthLeaders, Zebley said the fact that telehealth was included in the OBBBA is an indication that the Trump Administration is taking virtual care seriously – and is open to continued negotiation.

"I strongly suspect, based on past precedent, that we will see an extension, either through a health extenders package or, more likely, as part of a broader government funding bill," Zebley said. "The greatest concern with that path is the risk of a government shutdown, which is always a possibility in Washington but especially so given the heightened political tensions on Capitol Hill at this time.

"At the ATA and ATA Action, we're doing everything in our power to prevent even a momentary lapse in access," he added. "We're actively engaging with our bipartisan champions in both chambers to maintain urgency and keep this issue front and center. These programs have now been in place for more than five years and we must not only prevent disruption, but double down on making them permanent. Only then can we shift fully to advancing the next wave of opportunities in virtual care."

Compounding the urgency is the fast that while the deadline for those waivers is September 30, the House is now in its summer recess and won't return until the beginning of September.