October 1, 2025
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Dear Members, We understand one of the major concerns for our membership is expiring telehealth flexibilities in the context of the federal government shutdown. To recap, as many of you know, as of midnight Oct. 1, the federal government entered its first shutdown since 2019. On Tuesday night and again on Wednesday, the Senate voted down two continuing resolutions (CRs), or stopgap funding bills. For any proposal to pass, a 60-vote majority will be required in the Senate. Looking forward: Currently, the House is not in session, and negotiations in the Senate are at a relative standstill. The present dynamics make the odds for resolving the impasse quickly relatively low. At this moment, it’s difficult to tell if this shutdown will last for days or weeks. Telehealth: As it relates to telehealth, because congressional action was not taken before Oct. 1, Medicare telehealth flexibilities that needed a statutory extension have expired. See the HHS webpage for a list of Medicare telehealth flexibilities.Earlier today, CMS provided an update, stating in part: “Absent Congressional action, beginning Oct. 1, 2025, many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 public health emergency will take effect again for services that are not behavioral and mental health services. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas and hospice recertifications that require a face-to-face encounter. In some cases, these restrictions can impact requirements for meeting continued eligibility for other Medicare benefits.” We also wanted to provide answers to some questions we have received specifically regarding the telehealth in-person six-month prerequisite. As a reminder, prior to the onset of public health flexibilities in place following the COVID-19 Public Health Emergency (PHE) and continually renewed since the end of the PHE, as a precondition for the mental health telehealth services, an eligible beneficiary must have had an in-person appointment with the physician or practitioner within the prior six (6) months. These questions were posed to outside counsel and reflect their understanding of this issue, however we are also awaiting confirmation from CMS as it relates to each of the following questions: |
| Q:Does the 6-month requirement start on the day of the flexibility expiration, or will there be a different measure to determine when this requirement needs to be met by depending on when the individual initiated care? |
| A:It appears that the requirement starts on Oct 1, 2025, and will be applicable to any arrangement for the provision of Medicare mental health telehealth services commencing on this date or after. |
| Q:For beneficiaries that were not seen during the PHE but initiated care during the extension of the flexibility, would there also be an exception for the 6-month requirement if that interpretation still applies for these beneficiaries? |
| A:The 6-month prerequisite does not appear to apply to individuals whose mental health telehealth care has already been initiated (regardless of whether it was initiated during the PHE or since). Instead, since those individuals are already in established mental health telehealth care as of Oct 1, 2025, the applicable requirement would be that they have an in-person appointment at least annually. |
| Q:If the exception for initiation of care during the PHE applies, would it also apply to beneficiaries who received the service in a community location other than their home? |
| A:The 6-month in-person prerequisite would not apply to any patient whose mental health telehealth services have already been initiated as of Oct 1, 2025. Where they were located when they received the telehealth services should not make a difference. |
| The National Council will continue to provide updates on shutdown-related news as events continue to unfold. If you have any questions related to the potential shutdown or any other policy issues, contact the National Council Policy team at Policy@TheNationalCouncil.org. |