Telehealth Knowledge for 2025

Happy New Year. Here is information practitioners who provide care using telehealth need to know to practice effectively. After holding our breath about keeping the U.S. government open at the end of December, President Biden signed H.R.10545 ( American Relief Act, 2025) which included important telehealth measures including temporary extensions to continue Telehealth Flexibilities and the Acute Hospital Care at Home (AHCAH) program, both lasting through March 31, 2025.

Flexibilities in the bill, similar to those present during COVID-19 to increase access to care, include:

Continuing relaxation of geographic requirements and expanding originating sites for telehealth services allowing telehealth services to be delivered to any location in the U.S., including the home of an individual.
Expanding practitioners eligible to furnish telehealth services. In addition to physicians, nurse practitioners and physician assistant those eligible to furnish covered telehealth services include clinical nurse specialists, certified registered nurse anesthetists, certified nurse-midwifes, clinical social workers, clinical psychologists, registered dietitians or nutrition professionals, qualified occupational therapists, qualified physical therapists, qualified speech-language pathologists, and qualified audiologists.
Continuing telehealth services delivered by practitioners providing care in Federally Qualified Health Centers and Rural Health Clinics
Permitting covered practitioners to deliver telehealth services without a prior in-person exam for purposes of diagnosis, evaluation, or treatment of a mental health disorder.
Providing coverage with reimbursement for audio-only telehealth services. CMS is working to finalize permanent payment for two-way, real-time, audio-only communication technology for any Medicare telehealth service furnished to a beneficiary in their home if the distant site practitioner is technically capable of using an interactive telecommunications system, but the patient is not capable of, or does not consent to, the use of video technology.
Providing coverage and reimbursement for Telehealth encounters prior to recertification of eligibility for hospice care.

What did not get through?

Despite a bipartisan agreement earlier in December 2024 that providing additional telehealth services and flexibilities, final negotiations in the final days of December cut or decreased the following telehealth measures

Extending expanded Medicare telehealth billing by two additional years.
Continuing First-dollar coverage provision for High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs) allowing members to access telehealth services without meeting their deductibles or incurring out-of-pocket costs. Background: This regulatory exception program allowed members to retain HSA eligibility despite receiving these cost-free services which is generally not permitted. During COVID-19, reducing this financial barrier ensured that patients, including those facing economic challenges, could receive necessary care.
Cardiac and Pulmonary Rehabilitation: Providers will no longer receive reimbursement for cardiac and pulmonary rehabilitation services provided through telehealth to patients in their homes.
Coverage for telehealth delivery of the Medicare Diabetes Prevention Program (MDPP) Expanded Model has been removed. The MDPP worked to slow the rising number of patients with diabetes by preventing the onset of Type 2 diabetes for people with prediabetes. This program provided practical training and education empowering patients to manage their health.
Supporting the Patient Education and Knowledge (SPEAK) Act of 2023 required the Secretary of Health and Human Services to create a task force including stakeholders dedicated to improving language access in health care for Americans with limited English proficiency. SPEAK would have developed best practices for addressing barriers for people with limited English proficiency, leading to improved patient outcomes and reduced associated costs.

What’s Next?

With a number of programs set to expire March 31, 2025, and other program cuts, a number of healthcare technology organizations are contacting Congressional members encouraging:

Extension of telehealth flexibilities for a full year or more
Restating important telehealth programs agreed upon but

Individual letters and emails are also recommended to allow members to hear from practitioners and patients who depend on telehealth for quality care.

The bill also includes the extension of the geographic index floor through April 1, 2025, but it does not address Medicare payment cuts. While the bill originally included a 2.5% payment increase to offset the reduction in the Medicare Conversion Factor finalized in the physician fee schedule for 2025, it does not address the pending reduction in Medicare reimbursements. Any updates to Medicare payments will have to be addressed in 2025.

Nurse Practitioners might be interesting in other sections of H.R.10545 ( American Relief Act, 2025). In many cases the change made was extending the date, in some case there was a funding increase or a funds reduction.

Sec. 3101. Extension for community health centers, National Health Service Corps, and teaching health centers that operate GME programs.
Sec. 3102. Extension of special diabetes programs.
Sec. 3201. Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals.
Sec. 3202. Extension of the Medicare-dependent hospital (MDH) program.
Sec. 3204. Extension of funding for quality measure endorsement, input, and selection.
Sec. 3205. Extension of funding outreach and assistance for low-income programs.
Sec. 3208. Extending acute hospital care at home waiver authorities.
Sec. 3209. Extension of temporary inclusion of authorized oral antiviral drugs as covered part D drugs.
Sec. 3210. Medicare improvement fund.

TITLE III—HUMAN SERVICES

Sec. 3301. Sexual risk avoidance education extension.
Sec. 3302. Personal responsibility education extension.
Sec. 3303. Extension of funding for family-to-family health information centers.

TITLE IV—MEDICAID

Sec. 3401. Eliminating certain disproportionate share hospital payment cuts.

Please also check out the CMS Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule which includes information about new programs and regulations.

Please send questions or comments to DCNP.

Best wishes for a health and successful 2025.