Congress hesitates on long-term telemedicine expansion admid advocacy push
Efforts to extend telemedicine services permanently are facing hurdles in Congress, despite bipartisan support and widespread use of telehealth during the COVID-19 pandemic. Advocacy groups like the Medical Group Management Association (MGMA) continue to push for lasting solutions, while lawmakers grapple with concerns over cost, quality and fraud.
In a video interview with Health Exec, Anders Gilberg, MGMA senior vice president of government affairs, highlighted the importance of telemedicine, emphasizing how it became an essential tool for maintaining healthcare access during the pandemic.
"Telehealth wasn't even covered in Medicare outside of rural areas prior to the pandemic. And if you were in a rural area as a patient, you couldn't receive telemedicine in your home; you had to go to what was known as an originating site in order to be on a HIPAA secure platform and receive telemedicine, like your primary care physician's office," Gilberg explained. This was usually for specialty care that was not available in the patient's geographic area.
During the COVID-19 pandemic, it was critical to maintain the continuity of care and help people stay healthy—those who didn't have COVID but were afraid to come into the doctor's office due to the risk of contracting it. Emergency provisions by the Centers for Medicare and Medicaid Services (CMS) allowed millions of patients to access healthcare from their homes, bypassing the need to visit designated originating sites. This led to an explosion in the use of telehealth overnight.
There was certainly an exponential increase in the first years of 2020 and 2021. It's come down a bit and plateaued, but I think there's pretty strong support across the board, including bipartisan support in Congress. CMS is doing what they can to extend these flexibilities to allow patients outside of rural areas to receive telehealth in a more convenient manner other than through an originating site, and allow an expansion of practitioners to deliver telehealth beyond just physicians.
However, most of these expanded provisions were supposed to expire at the end of 2024, which led MGMA and other medical associations to lobby Congress to extend or make telehealth payments permanent.
Temporary extension wins
The American Relief Act of 2025 (HR 10545) was signed into law on Dec. 21 to avoid a government shutdown. It also included provisions to extend some telehealth flexibilities through March 31, giving Congress time to consider longer-term solutions. These include:
HR 10545 includes removing geographic requirements and expanding originating sites for telehealth services, expanding practitioners eligible to provide telehealth services, extending telehealth for federally qualified health centers and rural health clinics, delaying in-person requirements under Medicare for mental health services, allowing audio-only telehealth services, and extending the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care.
In November 2024, the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) extended provisions allowing telemedicine prescriptions for controlled medications through the end of 2025. MGMA welcomed the move, calling it a vital measure to prevent disruptions for patients who rely on telemedicine for medication access. However, the extension only temporarily addresses broader issues surrounding telemedicine's future.
Congress apprehensive about permanent extension
Gilberg said Congress has three primary concerns about making the extended telehealth policies permanent: quality assurance, fraud supervention and cost containment.
The most vocal critics argue that increased telehealth accessibility could drive up Medicare expenses without significantly improving care quality.
"There is concern that if telehealth is too accessible that you could increase volume in the Medicare program, potentially not improve quality and just drive up cost to a program, which is already strapped financially. And with the troubles in the Social Security and Medicare trust funds, there's going to be scrutiny on how much this is going to cost," he said.
Legislative stalemate on telemedicine, despite bipartisan support
Gilberg is hopeful legislation in Congress will extend telehealth flexibilities for an additional two years, allowing further study of its impact. He also expressed optimism about the bipartisan support for telehealth-related initiatives, but said the political climate in Washington complicates progress.
"There is tremendous support in Congress. Many of the issues I work on are completely bipartisan in nature. We have legislation that MGMA supports dealing with this issue on telehealth, dealing with the payment issue, also dealing with issues outside the fee schedule, like prior authorization reform that are bipartisan in nature. In this day and age, finding bipartisan agreement on issues in Washington isn't necessarily the easiest thing. So that's not the problem. I think the problem in Congress right now is just it's hyper political," Gilberg explained.
Even within the Republican caucus in the House of Representatives, the internal dynamics of the party will dictate the agenda. But many healthcare issues could be ignored for completely unrelated political reasons, despite the support.
"Unfortunately, the politics of Washington on unrelated issues often impact issues where there is bipartisan support," he said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com