Congress Creates Yet Another Cliff for Medicare Telehealth Extensions (and We’re Running Out of Metaphors)

The United States just made its latest move regarding Medicare telehealth flexibilities, which expired on September 30, 2025.

On November 9, the Senate voted 60-40 to end the then-nearly 40-day U.S. government shutdown, hammering out a continuing resolution (CR) that would extend the telehealth flexibilities extended in the Consolidated Appropriations Act of 2023 through January 30, 2026. The House vote on November 12, 222-209, clinched the deal.

It’s a welcome development. A research brief updated on November 10, 2025, by the Center for Advancing Health Policy Through Research (CAHPR) and the Brown University School of Public Health reports that telemedicine visits declined by 24 percent in the first 17 days of October for Medicare fee-for-service beneficiaries, and by 13 percent for Medicare Advantage beneficiaries. This is compared to visits from the start of July to the end of September, when the U.S. government’s failure to extend Medicare telehealth coverage sent practitioners and patients alike over what is now commonly termed a telehealth policy “cliff.”

Below, we examine where telehealth stands.

Back to the Future

As we wrote in March 2025, Congress began easing telehealth restrictions for Medicare beneficiaries in March 2020, during the COVID-19 pandemic. H.R. 2617, the Consolidated Appropriations Act of 2023, became law on December 29, 2022, allowing Medicare telehealth flexibilities to apply until December 31, 2024, if the public health emergency (PHE) ended before that date. As it happened, the PHE ended in May 2023.

Subsequent extensions. H.R. 10545, the American Relief Act of 2025, passed on December 21, 2024, and became Public Law No. 118-158. In Section 3207, it extended telehealth flexibilities through March 31, 2025. The ensuring March 31, 2025, deadline crisis was averted with H.R. 1968, the Full Year Continuing Appropriations and Extensions Act of 2025, which became Public Law No. 119-4 on March 15, 2025. As we wrote on March 25, Section 2207 of H.R. 1608—subsequently identical to Section 3207 of the American Relief Act of 2025—extended flexibilities until September 30.  

2026 Continuing Appropriations

H.R. 5371, signed by the president on November 12, 2025, allows, in Section 6208:—

• Medicare beneficiaries to continue to receive telehealth services at any site, regardless of type or location, including the beneficiary’s home (i.e., lifting geographic restrictions and maintaining an expanded list of originating sites to include patients’ homes);
• occupational therapists, physical therapists, speech-language pathologists, and audiologists to continue to furnish telehealth services (i.e., expanding the list of distant site practitioners who are eligible to bill Medicare for covered services to include any practitioner);
• federally qualified health centers and rural health clinics to continue to serve as distant site providers of telehealth services (i.e., expanding the location of the health care practitioner);
• a further delay of in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology;
• telehealth services to continue to be provided via audio-only technology; and
• hospice physicians and nurse practitioners to continue to complete certain requirements relating to patient certifications via telehealth.

The new H.R. 5371 also makes available more than $6 billion for telehealth for veterans. Note that Section 4121 of H.R. 2617, the Consolidated Appropriations Act of 2023, added marriage and family therapists, and mental health counselors (as Medicare practitioners/providers) under Part B of the Medicare Program, allowing them to be included in telehealth.

Remote Prescribing Flexibilities

As the shutdown progressed, ATA Action, the advocacy arm of the American Telemedicine Association, warned of another looming deadline for remote prescribing flexibilities. As we wrote in November 2024, the Telemedicine Flexibilities for Prescription of Controlled Medications end on December 31, 2025. During the PHE, the Drug Enforcement Administration (DEA) waived an in-person visit requirement before the prescription of controlled substances, and those flexibilities have been extended three times. 

2026 Physician Fee Schedule

Notably, on November 5, 2025, the Centers for Medicare and Medicaid Services (CMS) finalized the CY 2026 Payment Policies under the Physician Fee Schedule (PFS), which makes changes to the list of Medicare telehealth services outside of the temporary COVID-19 flexibilities. Among other things, the 1216-page PFS adds a number of services to the Medicare Telehealth Services List, including multiple-family group psychotherapy and group behavioral counseling for obesity (see page 49320). It also shortened the five-step process regarding requests to the Medicare Telehealth Services List and permanently removed frequency limitations on telehealth services relating to Subsequent Inpatient Visits, Subsequent Nursing Facility Visits, and Critical Care Consultation Services (49324-5).

Takeaways

While this latest development is a relief, it is clear that the issues surrounding the funding of Medicare telehealth—and telemedicine prescribing—are not going away every time Congress kicks the proverbial can down the road. The road simply leads to another “cliff” that the country must avert, be dangled over, and/or plunged over each time. In 2025, we know the consequences of letting the flexibilities expire—providers do not get paid, access to quality care is diminished, and questions of retroactive payment create uncertainty. If you have questions, please reach out to the authors.

Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this post.