Plunging Over the Telehealth Cliff: Now What?

The telehealth cliff that we warned you about on March 3 and March 25, 2025, is now more fact than fiction—and we need a parachute.

Current Medicare telehealth flexibilities expired on September 30, 2025. This expiration has come to be called a “cliff,” since millions of beneficiaries who have used telehealth as a means for receiving health care services since the COVID-19 pandemic could lose coverage for this benefit. Now, they may have to travel to a health care provider’s office or a health care facility to receive most telehealth services, as opposed to simply logging on at home.

Without question, this is a move backward. Since restrictions for Medicare beneficiaries were eased at the start of the global pandemic in March 2020, many Americans—including seniors, those in rural areas, and those with mobility problems—have learned not only to use telehealth but to embrace it and in fact rely upon it.

“We are asking—urging—Congress to not leave millions of patients and beleaguered healthcare providers dangling on the telehealth cliff while they deliberate over dynamics around a government shutdown,” Kyle Zebley, senior vice president of public policy at the American Telehealth Association (ATA) and executive director of the organization’s advocacy arm, ATA Action, said on September 23.

ATA Action also urged Congress to ensure retroactive reimbursement of telehealth services in the event of a government shutdown. Since March, some never lost sight of the issue, while others may have assumed that Congress would step in and act, as it did in the last few expirations. But embroiled in a government shutdown, the September 30 deadline has come and gone. What happens now?

On October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) released a special edition of its Medicare Learning Network (MLN) Connects, outlining how Medicare operations are being managed for claims, telehealth, and Medicare Administrative Contractors (MACs) during the ongoing government shutdown. As part of this update, CMS instructed MACs to place a temporary hold, which can generally last up to 10 business days, on claim payments. The hold is designed to ensure payment accuracy and compliance with statutory requirements, while also avoiding the need to reprocess a high volume of claims if Congress approves government funding. During this time, providers can continue submitting claims, but payments will not be issued until the hold is lifted.

Flexibilities

The COVID-19 public health emergency officially came to an end in May 2023, but the Medicare telehealth flexibilities were extended piecemeal as each subsequent extension ran out. The American Relief Act of 2025, passed in December 2024, created a 90-day extension of the Act through March 2025, in Section 3207. A House and Senate Continuing Resolution (CR) enacted on March 15 extended the telehealth flexibilities through September 30, 2025.

Section 2207 of the CR, “Extension of Certain Telehealth Flexibilities,” was substantively identical to Section 3207 of the American Relief Act (granting the extension for telehealth flexibilities through March 2025). So until September 30, this meant:

1. THEN: Geographic requirements were removed for telehealth services, and originating sites were expanded, by amending Section 1834(m) of the Social Security Act, 42 U.S.C. 1395m(m) (entitled “Payment for Telehealth Services”) (“the Act”).
   • NOW: As of October 1, Medicare will no longer reimburse telehealth visits for patients outside an approved originating site, or outside of certain geographic areas, which means that many beneficiaries will not be eligible to receive reimbursable telehealth services in their homes.
2. THEN: The list of practitioners deemed eligible to furnish telehealth services was extended by amending Section 1834(m)(m)(4)(e) of the Act, to include any practitioner who can independently bill Medicare for professional services, including physical therapists (PTs), occupational therapists (OTs), speech-language pathologists (SLPs), and audiologists.
   • NOW: “Practitioner,” for purposes of eligibility to provide telehealth services, is defined at Section 1842(b)(18)(c) to mean physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, nurse-midwives, clinical psychologists, social workers, registered dietitians, and nutrition professionals. Physicians, marriage and family therapists, and mental health counselors will also remain eligible to utilize telehealth.
   • NOW: PTs, OTs, SLPs, and audiologists will lose their eligibility to provide telehealth services to Medicare beneficiaries.
3. THEN: Telehealth services were extended to federally qualified health centers (FQHCs) and rural health clinics (RHCs), who may serve as distant site providers, by amending Section 1834(m)(8)(A) of the Act, 42 U.S.C. 1395m(m)(8)(A).
   • NOW: FQHCs and RHCs can still provide mental health visits through real-time audio and video telecommunications technology (and audio-only interactions in certain cases), as these are allowed in the definition of a “mental health visit” for FQHCs and RHCs. They can also continue to use telecommunications technology to provide “medical visits” through at least December 31, 2025.
4. THEN: Medicare in-person visit requirements for mental health services furnished through telehealth, which would require, with limited exceptions, that a patient have an in-person visit within six months prior to an initial telehealth visit and every twelve months thereafter, were delayed, by amending Section 1834(m)(7)(B)(i) of the Act, 42 U.S.C. 1395(m)(m)(7)(b).
   • NOW: In-person requirements are reestablished.
5. THEN: The furnishing of audio-only telehealth services that met the standard of care was allowed by amending Section 1834(m)(9) of the Act, 42 U.S.C. 1395(m)(m)(9).
   • NOW: Audio-only visits are not reimbursable except in certain limited circumstances, where the patient cannot or will not use video, but where the provider is technically capable of using audio-video technology.
6. THEN: The use of telehealth to conduct face-to-face encounters for recertification of eligibility for hospice care was allowed under Section 1814(a)(7)(D)(i)(II) of the Act, 42 U.S.C. 1395(f)(a)(7)(D)(i)(II).
   • NOW: Telehealth can no longer be utilized to conduct the face-to-face encounter required for hospice care eligibility recertification.

Takeaways

In spite of the lack of congressional action, politicians on both sides of the aisle recognize the importance of telehealth. H.R. 4206, the CONNECT for Health Act of 2025, was introduced in June (a Senate version, S. 1261, was introduced in April), and H.R. 5081, the Telehealth Modernization Act, was introduced in early September. Recent attempts to extend telehealth flexibilities in a continuing resolution—for example, H.R. 5371, H.R. 5450, and S. 2882—did not pass in time.

On September 19, 2025, the U.S. Senate passed S. Res. 417, designating the week of September 14 through September 20, 2025, as Telehealth Awareness Week—recognizing the impact of telehealth in delivering health care services for patients across the United States; and urging that steps should be taken to, among other things, “promote continuous access to telehealth for all communities and across settings.” Some of the points articulated in the resolution include:

• Telehealth plays a significant role in supporting access to quality health care services for millions of patients;
• Telehealth increases access to health care in areas with workforce shortages and for individuals who live far away from health care facilities, have limited mobility or access to transportation, or have other barriers to accessing care;
• Twenty-five percent of Medicare beneficiaries had at least one telehealth service in 2024;
• Any lapse in Medicare coverage for telehealth services could adversely impact patient access to care; and
• Legislative efforts to increase telehealth access have received bipartisan support in the Senate and House of Representatives.

We will see how well legislators live up to these aspirations.

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