Telehealth flexibilities expire amid government shutdown

By Jarrod Fowler, MHA
FMA Director of Health Care Policy and Innovation

The federal government officially shut down at midnight on Sept. 30 after Congress failed to pass a 2026 funding bill or short-term continuing resolution. While Medicare and Medicaid are classified as essential services and physician payments under both programs continue, critical health programs and flexibilities have expired, creating new uncertainties for physician practices nationwide.

Major rollback of telehealth waivers
Physicians who provide telehealth services to fee-for-service Medicare patients are facing immediate changes. Most of Medicare’s pandemic-era telehealth waivers have expired as of Oct. 1, and congressional action is required to restore them. Thus, Medicare telehealth coverage is once again limited to rural areas, as it was before the COVID-19 Public Health Emergency. Patients cannot receive telehealth services from their homes, except under specific circumstances.

Exceptions include:

• Treatment for mental health or behavioral health disorders, including substance use disorders.
• Stroke evaluation and management.
• Monthly end-stage renal disease (ESRD) visits for home dialysis patients.

All other non-rural Medicare beneficiaries are no longer eligible for telehealth visits, and the ability to provide audio-only services has also lapsed. The Acute Hospital Care at Home program, another major pandemic-era innovation, has ended as well.

According to the Centers for Medicare & Medicaid Services (CMS), clinicians who continue providing telehealth services that are not currently payable under Medicare should consider issuing Advance Beneficiary Notices of Noncoverage to patients, warning them that Medicare may not reimburse those services. The American Medical Association notes an important exception: Physicians participating in certain Medicare Shared Savings Program Accountable Care Organizations may continue to provide and be paid for telehealth services under their program-specific waivers.

Claims on hold
Despite the expiration of telehealth flexibilities, Medicare claim processing continues during the shutdown. CMS has clarified that physicians can still submit telehealth claims, but these claims will be placed on a temporary payment hold while Congress considers extending the waivers. 

If Congress restores the telehealth flexibilities, as most experts expect, payments will likely be made retroactively. However, there is no guarantee of payment if Congress fails to act. Due to the possible risk of non-payment, the CMS newsletter suggests “practitioners who choose to perform telehealth services that are not payable by Medicare on or after Oct. 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.”  Alternatively, some physicians may wish to temporarily convert to in-person visits.