Trends 2025: Telehealth's future faces a Friday deadline

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The future of telehealth and acute hospital care at home hangs on a spending bill that must be approved by the end of this week.

Three big provisions in the spending bill need to pass for providers to continue to use flexibilities first made available under the COVID-19 public health emergency. Only legislation can continue these flexibilities permanently.

The American Telemedicine Association's Kyle Zebley – who previously called 2024 the "Super Bowl for telehealth" – said Monday he expects a "clean sweep win."

"All three of those look like they will be taken care of in the spending bill," said Zebley, who is executive director of ATA Action, the organization's advocacy arm.

However, as of yesterday, the bill remains in negotiations in both chambers. The same bill must be agreed upon by both the House and Senate – it can't be amended in time for passage – before being sent to President Biden for his signature. All this must be done by Friday, Dec. 20, to avoid a government shutdown.

WHY THIS MATTERS

Congress is feeling the urgency to pass the spending bill before the federal government runs out of money on Friday.

"Everybody is trying to hitch a ride on a massive government spending bill," Zebley said.

Congress also recesses for the year at the end of this week. 

Technically, telehealth and other flexibilities don't expire until Dec. 31. 

"They don't expire until the stroke of midnight on New Year's Eve," Zebley said.

The big three are: Medicare telehealth flexibilities, which would be extended for two years; a tax policy provision, which allows individuals with high deductible health plans to get first dollar coverage of telehealth before hitting their deductible; and the acute hospital care at home program, which would be extended for five years.

Health systems have invested heavily in telehealth and in providing acute hospital care at home. The COVID-19 pandemic made both necessary, and providers want these provisions allowed by waivers from the Centers for Medicare and Medicaid to continue.

There's been such a huge investment in both, providers want them, and the provisions have bipartisan support, Zebley said. 

"That's why Congress won't let it lapse," he said.

What's at stake is telehealth policy that would revert to 1997. Without congressional intervention, telehealth would be limited to rural areas and would have to take place within the four walls of a medical office.

The Medicare acute hospital care at home program allows hospitals to get paid for providing acute care at home and also includes allowances for a sweep of technology services including monitoring, diagnostics and medical supplies, all within the home. More than 80 hospitals have participated, according to Zebley.

"This combined with other provisions are huge for hospitals," Zebley said. "It couldn't be more consequential to our community."

All of the big three have Republican support, he said.

Zebley said he expects the holidays to work as inspiration to get the job done before the stroke of midnight, Dec. 20. 

THE LARGER TREND

One telehealth provision has already been extended. 

In November, the Drug Enforcement Administration with HHS extended current telemedicine flexibilities for prescriptions of controlled medicines through Dec. 31, 2025.  

Email the writer: SMorse@himss.org