Telehealth Flexibilities Impacted by Government Shutdown

On October 1, 2025, the federal government entered a partial shutdown halting many government operations. Congress was not able to pass a measure to extend the temporary waivers that allow Medicare patients to continue accessing telehealth services from their homes before entering the shutdown. Because of this, telehealth flexibilities lapsed for patients receiving services in their homes, except for those being treated for behavioral health or substance use disorders, and telehealth services are again limited to only being covered when provided in the originating sites that were acceptable before the public health emergency waivers. In addition, no extension was passed for the Acute Hospital Care at Home initiative, so that has also lapsed.

CMS has suggested that providers who choose to continue providing telehealth services under the flexibilities consider providing beneficiaries during this period with an Advance Beneficiary Notice of Noncoverage (“ABNs”) informing them that the services may not be covered. Unfortunately, for many providers, it is challenging to roll out ABNs in a telehealth environment without time to implement an effective process. In addition, many patients being presented with ABNs may opt not to receive services rather than potentially be required to pay for those services out of pocket, particularly in light of the uncertainties of when the government shutdown will end and whether Congress will ultimately approve a retroactive extension of the telehealth flexibilities. This will negatively impact access to services and continuity of care for such beneficiaries. An alternative to obtaining ABNs is for providers to hold claims until the government shutdown ends, in the hope that Congress will retroactively approve an extension of the telehealth flexibilities, at which point the claims can be submitted as reimbursable services. If claims have already been submitted that depend for coverage on the expired telehealth flexibilities, we recommend that providers flag these claims as potentially requiring repayment if the telehealth flexibilities are not eventually extended.

Providers participating in certain Medicare Shared Savings Program (“MSSP”) Accountable Care Organizations (“ACOs”) may be insulated from the impact of this situation. CMS already permitted beneficiaries assigned to certain ACOs to receive telehealth services in their homes through flexibilities through the MSSP. See the “Medicare Shared Savings Program Telehealth Fact Sheet,” available here. Therefore, the failure to extend the telehealth flexibilities does not impact these services.