CMS provides telehealth update amid government shutdown
Over the last five years, healthcare organizations have provided services using waivers and flexibilities designed to expand Medicare beneficiaries’ access to telehealth during the COVID-19 pandemic. Some of these flexibilities have already expired or been made permanent, but certain provider type, location, technology, and in-person requirements have continued to be waived.
The last remaining flexibilities were set to expire on September 30, but many industry experts expected CMS and Congress to pave a new path forward for these services before reaching what is known as the telehealth policy cliff. However, lawmakers failed to pass a funding bill for fiscal year 2026, and Medicare telehealth policy has reverted to its pre-COVID-19 pandemic state.
“The expiration of the telehealth flexibility extensions will primarily affect beneficiaries in non-rural locations and who were receiving physical therapy, occupational therapy, and speech-language pathology,” says Kimberly Hoy, JD, CPC, senior regulatory specialist for HCPro. “It’s important to remember that remote mental health services, sometimes referred to as telehealth, are separate and were made permanent, so they are unaffected by the expiration of the location and provider flexibilities.”
As healthcare organizations continue to navigate the government shutdown, CMS recently provided an update on Medicare operations via a special edition of its MLN Connects® newsletter. The agency directed all Medicare Administrative Contractors to implement a temporary claims processing hold. This practice is standard when certain legislative payment provisions are scheduled to expire, and it typically lasts up to 10 business days.
The hold prevents the need for reprocessing large claim volumes if/when a resolution is reached and should have a minimal impact on providers, according to CMS. Organizations may continue to submit claims during the hold period, but payment will not be issued until the hold is lifted.
Additionally, CMS urged organizations that furnish non-payable telehealth services on or after October 1 to consider providing Medicare beneficiaries with an Advance Beneficiary Notice of Non-Coverage.
As the government shutdown continues, healthcare organizations must monitor for the latest news and regulatory developments, as well as further instructions from CMS. Review Medicare telehealth policies and ensure staff members understand how the shutdown impacts operations and claims processing.
Update: On October 15, CMS published an update clarifying that it will continue to pay and process held claims in a timely fashion "with the exception of select claims for services impacted by the expired provisions." CMS noted that, as of October 15, no payments have been delayed because statute already requires a 14 day claim hold. The agency clarified that providers may continue to submit claims.