Telehealth Under Medicare in 2023 and Beyond
By Jarrod Fowler, MHA, FMA Director of Health Care Policy and Innovation | Originally published Dec. 1, 2022, updated Jan. 12, 2023

Throughout the COVID-19 pandemic, many physicians have utilized flexibilities granted under the Public Health Emergency (PHE) to deliver telehealth services to Medicare patients. These flexibilities have included the elimination of geographic and site of service restrictions, payment for audio-only telehealth visits, and more. They have become widely popular with patients and physicians alike, serving to protect medically vulnerable patients from infection and eliminating the difficulty and/or inconvenience associated with traveling to in-person appointments.

When will these flexibilities expire?
After the passage of the omnibus bill at the end of 2022, telehealth flexibilities will now expire at the end of 2024. Future action from Congress could extend this deadline. Under current law, most flexibilities will expire 151 days after the end of the PHE, which is currently set to end on Jan. 11, 2023. However, it appears likely that the PHE will soon be extended for an additional 90-day increment. This is because the U.S. Secretary of Health and Human Services has stated that he will provide a 60-day notice prior to the PHE’s expiration, and the timeframe for him to give that notice before Jan. 11 has passed.

What will change once the current flexibilities expire?
The Centers for Medicare & Medicaid Services has created a helpful website for navigating the end of the current flexibilities associated with telehealth. Most notably, 151 days after the end of the PHE, prior geographical and site of service restrictions will be reinstated outside of certain mental/behavioral telehealth visits, which will severely curtail telehealth access for Medicare patients. Instead of telehealth being accessible everywhere, with respect to traditional Medicare, telehealth use will be relegated largely to patients who live in rural areas and travel to specified originating sites of services. Payment for audio-only services outside of certain mental/behavioral telehealth visits also will come to an end.

Certain flexibilities will end immediately upon the PHE’s expiration rather than being phased out over 151 days expiring at the end of 2024. These include certain HIPAA requirements related to remote communications technology, including audio-only services. More information can be found here.

Do the flexibilities associated with the PHE stand any chance of becoming permanent?
While a handful of permanent changes have been codified, Congress has yet to pass a bill that would extend most telehealth flexibilities past the aforementioned deadlines. While the U.S. House of Representatives passed a bill to extend the current flexibilities through 2024 by an overwhelming 416-12 margin, the Senate has yet to act on this legislation. The process of crafting this legislation into law will reset once the next Congress is seated now that the 118th Congress has begun. According to Sen. Brian Schatz (D-Hawaii), the Congressional Budget Office may prove to be the biggest challenge. As Sen. Schatz said in an interview with Politico, “There’s no evidence at all in the real world that telehealth costs more money, but the idiosyncrasies of CBO scores sometimes make it seem like it’s an expensive proposition.”