Telehealth, Hospital at Home flexibilities get another short extension

Congress has done it again…at least for a little while. As part of the federal stopgap legislation to keep the government open, lawmakers have included language to extend certain of the pandemic-era telehealth flexibilities that have proved so popular with remote care providers as well as an extension of the Acute Hospital Care at Home (AHCAH) waiver. 

However, the reprieve is a short one, and the rules are once again set to expire on September 30, 2025, unless lawmaker step in to take the flexibilities off the chopping block one more time.  

Keeping telehealth alive for Medicare beneficiaries

“This is a big victory for telehealth, and a huge relief for patients and clinicians in every state and region of the United States, especially those in underserved communities,” said Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telehealth Association. “By including these provisions in this stopgap legislation, Congress sent a very clear message that telehealth is a fundamental part of care delivery, and that we must not reverse the significant progress made in modernizing our healthcare system.” 

The latest telehealth legislation will allow providers to continue offering a number of services that were first incorporated into Medicare to support virtual care during COVID-19, including allowing Medicare beneficiaries to receive telehealth services in their homes instead of only at approved health care facilities. Beneficiaries can also continue to receive virtual care from providers such as mental and behavioral healthcare providers, occupational and physical therapists, speech-language pathologists, and audiologists. 

In addition, Federally Qualified Health Centers (FQHCs) and rural health clinics (RHCs) will continue to be allowed to provide telehealth services to patients in distant locations, and can keep offering behavioral and mental health services virtually without a requirement for periodic in-person visits for the moment. 

Hospital at Home gets a little bit more breathing room

The budget bill also adds some time to the ticking clock for the Medicare Acute Hospital Care at Home (AHCAH) program, which has been similarly extended until the autumn of 2025. The popular initiative allows hospitals to receive reimbursement parity for managing certain patients remotely instead of in the inpatient setting, allowing health systems to save beds and patients to receive comparable care in the comfort of their own homes.  

Early evidence shows that Hospital at Home (H@H) programs can save costs without compromising on outcomes, while simultaneously producing satisfied patients who largely prefer remote care to the experience of an inpatient admission. 

Health systems and professional societies have been strongly advocating for a permanent continuance of the Hospital at Home strategy, but lawmakers have not yet acquiesced.  

The challenging ripple effects of repeated six-month extensions

Telehealth and H@H programs require significant investments and alternations to traditional in-person workflows, which are not easy to make or sustain when these initiatives face the threat of sudden shutdown every six months or so. And with the determinations being folded into the high-stakes political brinkmanship of government funding debates, health systems can never be quite certain if they’ll find their telehealth capabilities swept out from under them at any moment. 

In addition to providing stability for health systems looking to expand virtual care options for Medicare beneficiaries, a more certain long-term extension could be good for bringing similar services to Medicaid, argues the American Hospital Association (AHA). 

“A long-term extension will not only provide additional time to continue gathering data on quality improvement, cost savings, and patient experience, but will also provide much needed stability for new programs and may ease state concerns about updating Medicaid policies to allow for coverage of these services,” the organization said in a January 2025 fact sheet.  

At the moment, few states have allowed Medicaid to cover at-home hospital services, with only 12 state programs including Medicaid coverage for such initiatives as of June 2024, according to the AHA.   

With state Medicaid agencies facing steep cuts from the Trump Administration’s plans to eviscerate up to $880 billion in Medicaid spending over the next decade – close to a third of most states’ Medicaid budgets – cost-saving ideas like H@H could be vitally important to ensure continuance of services to at-risk populations. 

But without the stability of a permanent program to generate additional proof that H@H works at scale, Medicaid agencies are unlikely to invest their shrinking dollars in something that could disappear in an instant. 

To support the continued growth of telehealth, lawmakers will need to work with industry representatives to come to a consensus on making regulations more reliable for a longer period of time.  Doing so will encourage investment and innovation in remote care strategies that have become popular with providers and patients alike while achieving savings for the health system at large – a rare instance of a win-win situation in healthcare. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].