Government Shutdown Looms: How the Medicare Telehealth Cliff Impacts Providers and Patients Starting October 1
Background on Pre-Shutdown Telehealth Flexibilities
Congress first implemented the Medicare telehealth flexibilities during the COVID-19 PHE in 2020. The Federal government took a range of steps to expedite the adoption and awareness of telehealth, which included:
Geographic and Originating Site Flexibility
Medicare patients could receive telehealth services in their homes through September 30, 2025. There were no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through September 30, 2025.
Additional Provider Type Eligibility
Telehealth services could be provided by all eligible Medicare providers through September 30, 2025, which included occupational therapists, physical therapists, speech language pathologists, and audiologists.
Expansion of Audio-Only Telehealth
Non-behavioral/mental telehealth services could be delivered to Medicare beneficiaries using audio-only communication platforms through September 30, 2025.
FQHC Flexibility
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as Medicare distant site providers for non-behavioral/mental telehealth services through September 30, 2025.
Waiver of the Behavioral Health Visit In-Person Requirement
An in-person visit within six months of an initial Medicare behavioral/mental telehealth service, and annually thereafter, was not required through September 30, 2025.
Behavioral/Mental Health Telehealth Services do NOT Sunset on September 30, 2025
For behavioral/mental health in Medicare, home as an originating site and audio-only are permanent, and FQHCs/RHCs can be distant sites for behavioral health on a permanent basis.
Congress has extended these flexibilities multiple times since the end of the PHE, with the latest extension through September 30, 2025, as enacted in the 2025 Full-Year Continuing Appropriations and Extensions Act (the “Act”).
How will the Government Shutdown Affect Telehealth Flexibilities?
The Act funded the federal government through September 30, 2025. Because the flexibilities were included in the Act, they will terminate unless an appropriations bill or a continuing resolution is enacted by September 30, 2025. If a new continuing resolution does not pass or does not include a provision to extend telehealth flexibilities, those flexibilities will terminate, and Medicare Part B telehealth policies will revert to the pre-pandemic environment. As of October 1, 2025, these changes may include:
Return of Geographic and Originating Site Requirement:
Medicare patients can only receive telehealth services for non-behavioral/mental health care from specific originating sites, such as a provider’s office, a hospital, or a skilled nursing facility, starting October 1, 2025.
Limited Provider Type Eligibility
The list of eligible providers will be limited to physicians, physician assistants, advanced practice registered nurses, certain behavioral health providers, and registered dietitians or nutrition professionals.
Audio-Only Telehealth Ends
Audio-only telehealth services will only be covered for Behavioral/Mental Health.
RHC/FQHC Flexibility as Distant Sites Ends
For non-behavioral/mental telehealth, these rural entities may no longer serve as distance sites. However, they may continue to do so for behavioral/mental telehealth.
Waiver of the Mental Health Visit In-Person Requirement
For diagnosis, evaluation, or treatment of a behavioral health disorder via telehealth to be covered by Medicare, an in-person visit will be required within six months before the initial telehealth visit and every 12 months thereafter, with limited exceptions.
Roadmap for Telehealth Providers: What are My Options and Responsibilities if Congress fails to enact legislation to retain telehealth flexibilities?
Assess Your Patient Population: Identify patients that are covered by Medicare with upcoming telehealth appointments. If you serve patients across Medicare, Medicaid, and commercial payers, it will be crucial to identify which patients are immediately impacted by the termination of telehealth flexibilities. It is important to note that Medicare Advantage plans may choose to continue telehealth services without the geographic and originating site restrictions.
Patient Communications: Send an explicit notice to affected patients explaining whether their upcoming telehealth visit will continue, be converted to phone, or be moved in-person, and why. IF you choose to continue the telehealth visit, notify the patient that Medicare may NOT cover the visit, and that the patient may be financially responsible for the visit. This notice should be in the patient’s EHR, and a broader email notice may also be warranted.
Staff and Provider Education: Patient onboarding and scheduling workflows may change dramatically if telehealth flexibilities expire. Ensure that your front-line administrative and provider staff are aware of these changes to mitigate service disruptions.
Reimbursement and Cash Flow: It is possible, but not guaranteed, that CMS will apply a retroactive reimbursement policy to telehealth claims submitted between October 1, 2025, and the date of an official reinstatement of telehealth flexibilities. Therefore, if you do decide to see patients via telehealth, it is essential to budget for the added up-front costs until a reinstatement occurs. There is no set timeline for when a reinstatement would take effect.
Payor and Provider Agreement Reviews: While Medicare telehealth flexibilities are terminated, most commercial plans (including MA plans) and Medicaid still provide coverage for telehealth under the pandemic-era framework adopted by CMS. Although Medicare rules set the floor, commercial plans and Medicaid may also terminate telehealth flexibilities. Until you receive notice of a change in any plans’ coverage of telehealth, you should immediately review your provider and/ or plan agreement to identify whether their telehealth reimbursement policy is tied to that of Medicare.
Hybrid Strategy and Staffing: If you are a provider with an in-person clinic, be prepared for an uptick in volumes if you convert telehealth appointments to in-person visits. In addition to scheduling appointments, you must ensure that your staffing strategy is scalable and that state-specific supervision laws are taken into account.
Compliance and Appeals: If a reinstatement occurs, and claims are denied because flexibilities were rescinded, be ready to appeal with documentation showing you complied with guidance in effect at the time of service (consent, clinical necessity, and the type of technology used – audio video versus audio only).
Go-Forward Advocacy: Participate in professional groups or state medical societies pushing Congress/ the Trump administration to extend or codify telehealth flexibilities.
Nixon Law Group advises digital health companies, providers, and investors on compliance, reimbursement eligibility, and regulatory strategy. Contact us if you would like guidance as you navigate these challenges.