Can Congress Be Convinced to Take Telehealth Seriously?

The stopgap budget bill gave key telehealth and Hospital at Home waivers a three-month reprieve. Supporters now have to convince a fractured Congress and new Administration that these waivers are crucial enough to be made permanent.

Telehealth and digital health policy will remain a hot topic in early 2025. But will three months be enough time to convince a fractious Congress and new Administration of the benefits of permanent coverage?

Telehealth advocates and supporters of the Hospital at Home strategy are celebrating what amounts to a moral victory in the last-minute passage of a stopgap budget bill. The 100-page bill—which originally clocked in at 1,500 pages before it was pared down to make the grade—includes extensions of key telehealth waivers and a continuance for the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCAH) program.

But those waivers only extend another 90 days—barely enough time to schedule an in-person doctor’s visit--and several other digital health and telehealth provisions were cut.

Supporters are now continuing their full-court press on Congress to make those provisions permanent, something they’ve been working on for several years. They’re hoping the letters to lawmakers signed by hundreds of healthcare organizations and support of dozens (if not hundreds) of House and Senate members will sway Congress.

“We will immediately begin working to ensure Congress makes Medicare telehealth flexibilities and the Acute Hospital Care at Home Program permanent—or secures a much longer extension than 90 days,” Kyle Zebley, senior vice president of public policy for the American Telemedicine Association and executive director of ATA Action, the group’s lobbying arm, said in a press release. “Simultaneously, we will advocate vigorously to reinstate the vital provisions that were left out of this package.”

On one hand, supporters are encouraged by the fact that the telehealth and ACHAH waivers made the cut for the three-month extension—meaning Congress thinks they have enough value to continue. On the other hand, those waivers have been extended before, and the incoming Trump Administration has signaled its interest in cutting costs and reducing administrative clutter. The challenge will be on supporters to push the value in making these waivers permanent.

The final bill includes a 90-day extension (instead of two years, as was in the original bill) on several telehealth flexibilities enacted by CMS during the COVID crisis to expand coverage of and access to telehealth. They 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.

In addition, the bill extends the CMS waiver for its AHCAH program for three months, instead of five years, enabling the more than 350 health systems following the CMS model to receive Medicare reimbursement.

Among the telehealth provisions that were cut out of the final package:

• First dollar coverage of High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs);
• Support for virtual care providers in the Medicare Diabetes Prevention Program;
• Improved coverage for digital health in home-based cardiology and pulmonary rehab programs; and
• The SPEAK Act (HR 6033), which paves the way for accessible telehealth services.

CMS has already said it won’t extend the waivers any more (though the agency did include some telehealth, remote patient monitoring and digital therapeutic improvements in its 2025 Physician Fee Schedule). So it's up to Congress to decide if there's enough value in the waivers to make them permanent.