Telehealth, hospital-at-home waivers extended for 90 days

Following a tumultuous battle of wills, Congress narrowly averted a government shutdown, passing a year-end spending bill that includes a three-month extension for pandemic-era telehealth flexibilities and the Acute Hospital Care at Home (AHCAH) waiver that were slated to expire at the end of the year.

Congress extended the regulatory flexibilities that propelled telehealth adoption and hospital-at-home care models nationwide after President-elect Donald Trump shot down a bipartisan agreement last week. The initial legislation would have extended telehealth flexibilities through 2026 and the AHCAH waiver through 2029.

The House passed the new bill, the American Relief Act, 2025, on Dec. 20, 2024, after a different Trump-endorsed funding bill failed to pass the previous evening. The Senate approved the new funding bill on Dec. 21, 2024, and President Joe Biden signed it into law soon after. The legislation funds the government through mid-March.

The legislation also extends various telehealth waivers for the Medicare program through March 31, 2025, including those that eliminate geographic restrictions and expand originating sites for telehealth services, expand the types of healthcare practitioners eligible to provide telehealth services and allow rural health clinics and federally qualified health centers to continue to offer telehealth. Additionally, the waivers include coverage for audio-only telehealth and allow telemental health visits to be furnished without prior in-person appointments.

However, some provisions in the initial bipartisan bill were not included in the final bill that became law. These include the first-dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision, which allowed Americans with HDHP-HSA accounts to access telehealth without meeting their deductible, and in-home cardiology rehabilitation flexibilities.

The bill further extends the AHCAH waiver through March 31, 2025. Initially launched by the Centers for Medicare and Medicaid Services in November 2020, the waiver suspends various Medicare Hospital Conditions of Participation for approved Medicare-certified facilities, enabling them to provide hospital-level acute care in patient homes. As of Nov. 27, 2024, 378 healthcare facilities across 39 states had been approved for the waiver.

CMS has assessed the program, finding that the quality of care provided under the AHCAH program was on par with or better than that provided in brick-and-mortar inpatient settings.

Though telehealth stakeholders appear disappointed with the shortened extension, they expressed relief and highlighted plans to double down on advocacy efforts in the new year.

"While we are grateful lawmakers averted a year-end telehealth cliff for millions of Medicare beneficiaries, the fact Congress was only able to secure a short-term extension of critical flexibilities and the significant uncertainty the process created for providers and patients underscores the urgent need for permanent solutions," said Alye Mlinar, executive director of Telehealth Access for America, in an emailed statement.

Leaders at the American Telemedicine Association (ATA) echoed this sentiment.

"While we are encouraged that the Medicare flexibilities and AHCAH have been given a short-term extension, this is still far from an ideal outcome," said Kyle Zebley, senior vice president of public policy at the ATA and executive director of its advocacy arm, ATA Action, in a press release. "We will continue to foster positive and productive collaboration with Congress and the White House, and expect even more work ahead, with heightened urgency, in the coming months with a new administration and Congress to ensure that high-quality patient care is uninterrupted."

Zebley noted that the ATA plans to work toward making the telehealth flexibilities and AHCAH waiver permanent or securing a much longer extension. The association also plans to advocate for the reinstatement of the provisions that were cut.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.