[co-author: Joel Dankwa]
Since we published an update on the expiring telehealth flexibilities last week, the government has entered the third week of shutdown with no signs of an imminent resolution. As uncertainty around the treatment and future of these flexibilities continues to grow, both industry and CMS have weighed in:
- On October 14, the American Telemedicine Association’s advocacy arm released a statement urging Congress and the current administration to quickly enact a short-term solution for the expiring flexibilities. The statement noted that many commercial insurers follow Medicare coverage and payment policies, such that the expired flexibilities could result in uncertainty and reduced coverage of telehealth across the healthcare market.
- On October 15, CMS published an MLN Connects Newsletter Update stating that CMS had instructed all MACs to continue temporarily holding claims with dates of services of October 1, 2025 and later that were impacted by the expired telehealth flexibilities. Telehealth service providers can reasonably infer from CMS’s instruction to MACs to continue to hold such claims (i.e., not to begin to deny them), that the claims may yet be determined on some future date to be payable (although such determination may hinge on Congressional action). Although providers can continue submitting these claims, payment (if available) will not be released until the hold is lifted. The update also recommended that practitioners who provide telehealth services that are no longer payable by Medicare on or after October 1, 2025 consider providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.
- Also on October 15, CMS initially stated that it would pause all Medicare payments impacted by the expired provisions, but later changed course and indicated that the agency would “continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions.” The scope of this course change – and its alignment or lack thereof with CMS’s direction to the MACs – remains unclear.
This barrage of shifting and inconsistent guidance has offered little comfort or clarity for providers furnishing telehealth services. Providers furnishing telehealth services should continue to monitor closely for further developments.
