Telehealth waivers are poised to expire: Questions and answers

Congress is moving closer to a partial government shutdown, as lawmakers remain at odds on a deal for a short-term spending plan.

Telehealth waivers are slated to expire at the end of the month, and healthcare groups are pressing Congress to extend them.

Healthcare advocates are pressing Congress on some key priorities, including telehealth programs, because waivers authorizing those programs are poised to expire at the end of the month.

And it’s a situation that’s been all too familiar for hospitals and providers utilizing telehealth programs.

Here’s a rundown of what’s happening.

Q: Why is telehealth on the brink?

A: When Congress last approved a short-term spending bill in March, the legislation only funded government programs through the end of September. And the clock is ticking.

As part of that legislation, Congress also approved the extension of telehealth programs, which were poised to expire. But the extensions only run through the end of September.

Former President Biden and Congress brokered a two-year extension of telehealth waivers in 2022, but it expired at the end of 2024. And since then, lawmakers have granted only short-term extensions, first in December 2024 and then again in March.

Q: Are telehealth programs truly at risk?

A: While healthcare groups have expected that telehealth waivers will ultimately be granted, advocates are getting nervous, because there’s only a week left before the government runs out of money. Congress is out of session this week and isn’t set to return until Sept. 29.

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, says the situation is causing anxiety.

“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,” Zebley said in a statement.

Q: What about hospital-at-home programs?

A: The waivers cover all telehealth programs, including programs providing acute care at home via telehealth. While the government requires hospital-at-home programs to provide some in-person visits from nurses, these programs also involve virtual care.

If there’s not a resolution and waivers aren’t extended, Zebley said, health systems offering hospital-at-home programs could see “major disruption.”

“Hospitals and clinicians will struggle to sustain telehealth-based care if reimbursement disappears. It’s untenable,” Zebley said.

As of Sept. 22, there are 419 hospital-at-home programs operating in 39 states, according to data from the Centers for Medicare & Medicaid Services. There are 147 health systems operating those programs.

Q: Do lawmakers support telehealth?

A: Republicans and Democrats in Congress have shown strong support for telehealth in the past.

When it comes to telehealth, Zebley told Chief Healthcare Executive® in July, “There’s essentially universal support on Capitol Hill,” Zebley says.”

As part of the sweeping tax package approved in July that is expected to leave millions without Medicaid coverage, telehealth scored a win. Lawmakers inserted a provision that reinstates first-dollar coverage for telehealth for Americans using High-Deductible Health Plan-Health Savings Accounts.

Telehealth isn’t preventing lawmakers from reaching a spending deal. The issue of extending Affordable Care Act tax credits, however, is very much a key part of the Clash in Congress.

President Trump has been a supporter of telehealth, Zebley has said.

Q: What are hospitals doing?

A: Hospitals are pressing Congress to extend waivers for telehealth programs.

The American Hospital Association placed telehealth programs high atop their priorities in Washington in a letter sent to congressional leaders in both parties.

“Telehealth provides a tremendous ability to leverage geographically dispersed provider capacity to support patient demand,” the association said.

Q: Is there any chance of a long-term extension for telehealth programs?

A: In all likelihood, Congress will probably sign off on another short-term extension, tied to a temporary spending bill, advocates have said.

Healthcare groups have been pushing for lawmakers to approve permanent waivers, or, at minimum, a multi-year extension of those programs.

“Congress should permanently adopt telehealth waivers and expand the telehealth workforce,” the hospital association said in its letter to Congress.

The American Hospital Association has said the inability of Congress to approve permanent or even long-term waiver have deterred some health systems from launching hospital-at-home programs.

Q: What if a shutdown happens?

A: The American Telemedicine Association is hoping a deal will be reached that includes extending telehealth programs. But the group is also hoping that providers and patients won’t pay the price if there is a shutdown.

“We should at least give providers some reassurance that they will receive back payment for essential healthcare services delivered during this shutdown,” Zebley said.