Medicare Telehealth Flexibilities: Countdown to January 30, 2026 (and What Comes Next)

主なポイント

• The Medicare telehealth flexibilities are set to expire on January 30, 2026. Without Congressional action, Medicare coverage for telehealth services will revert to the limited pre-COVID-19 framework.
• The House has passed legislation that would extend the flexibilities through December 31, 2027, but the bill still needs to pass the Senate and be signed into law.
• Due to disagreement in Congress over Department of Homeland Security (DHS) funding, the risk of another partial government shutdown and lapse in the flexibilities is increasing.
• The Centers for Medicare & Medicaid Services’ (CMS) response during the lapse of telehealth coverage in fall 2025 provides a roadmap for providers on what to expect.

何が懸かっているのか

Without an extension from Congress, the Medicare telehealth flexibilities will expire on January 30, 2026. This would mean that Medicare telehealth coverage, as we have known it for nearly six years, would revert to a time when Medicare generally covered telehealth services only for beneficiaries located in rural areas, at a limited set of originating sites (such as hospitals, clinics, and skilled nursing facilities), and when services were furnished by a much narrower group of practitioners. Under this framework, coverage of telehealth services for Medicare beneficiaries is significantly narrowed, making telehealth less accessible for many beneficiaries due to cost concerns. For a more detailed discussion of what Medicare telehealth policy looks like after expiration, see our prior comments “Medicare Telehealth Flexibilities: Countdown to September 30, 2025.”

Where Congress Stands Now

On January 22, 2026, the House passed H.R. 7148, the 2026 Consolidated Appropriations Act, which includes the FY 2026 appropriations package for Defense, Labor, Health & Human Services, Education, Transportation, Housing and Urban Development, and related agencies. The spending bill would extend the Medicare telehealth flexibilities through December 31, 2027, and the Acute Hospital Care at Home initiative through September 30, 2030. 

The current dispute over DHS funding, including disagreement among Senators regarding how to fund and oversee agencies such as Immigration and Customs Enforcement following recent federal law enforcement encounters in Minneapolis, increases the likelihood of another government shutdown that could temporarily disrupt Medicare telehealth coverage. However, because there is little disagreement in Congress over maintaining telehealth access for Medicare beneficiaries, it is likely that any final spending package will include some form of an extension of the Medicare telehealth flexibilities. That said, because the flexibilities are entangled with the broader DHS funding debate, it is unclear whether Congress will enact the proposed two-year extension or instead rely on shorter-term extensions.

簡略な歴史 

Congress first implemented the Medicare telehealth flexibilities during the COVID-19 Public Health Emergency (PHE) in 2020. The flexibilities were later extended, or made permanent in certain cases, through the 2021 Consolidated Appropriations Act (CAA), 2022 CAA, 2023 CAA, 2025 American Relief Act, 2025 Full-Year Continuing Appropriations and Extensions Act, and most recently through the 2026 Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act, which extended the flexibilities through January 30, 2025. For more details, refer to some of our prior discussions about the extensions:

• “Medicare Telehealth Flexibilities Have Expired” (October 2025)
• “Medicare Telehealth Flexibilities: Countdown to September 30, 2025” (September 2025)
• “Medicare Telehealth Flexibilities Get a Three-Month Lifeline” (December 2024)

How CMS Handled the Last Lapse

During the funding lapse in late 2025, CMS directed all Medicare Administrative Contractors (MACs) to place a temporary hold on telehealth claims and to return, rather than deny, telehealth claims submitted during the lapse period that could not be paid under the pre-COVID-19 coverage framework. CMS also advised providers to assess whether it was appropriate to issue beneficiaries an Advance Beneficiary Notice of Noncoverage.

After coverage was restored retroactively, CMS instructed providers to resubmit telehealth claims that had been returned by MACs during the lapse period and to submit all telehealth claims that had been held, provided those claims met all applicable Medicare requirements. CMS also encouraged providers to identify beneficiaries who were charged for telehealth services during the lapse period due to non-coverage for services that later became payable and to submit claims to Medicare and refund any resulting overpayments to those beneficiaries.

What Providers Should Do Now

Given the approaching deadline for the flexibilities and likelihood of another lapse, providers furnishing telehealth services should consider doing the following:

• Prepare for a brief lapse in Medicare telehealth coverage, including a plan for decisions around scheduling, billing, and the timing of claims submissions, in the likely event coverage is later restored retroactively.
• Track telehealth claims provided during any lapse period so those claims can be held, flagged, or resubmitted if coverage is reinstated.
• Prepare patient communications in advance explaining that Medicare telehealth coverage may change, including that visits may need to be rescheduled, converted to in-person, billed differently, or may become non-covered if a lapse occurs.
• Closely monitor future Congressional action on appropriations to quickly adjust scheduling, billing, and care delivery if coverage is restored.

結論

Without Congressional action, the Medicare telehealth flexibilities will revert, once again, to the pre-pandemic framework on January 31, 2026. Although the House has passed legislation that would extend the flexibilities through December 31, 2027, Senate action remains uncertain. Despite continued bipartisan support for preserving Medicare coverage of telehealth services, the extension is part of a broader appropriations package that has become tied up in disputes unrelated to telehealth policy, most notably negotiations over DHS funding. 

As a result, providers should be prepared for the possibility of another short-term lapse in Medicare telehealth coverage, probably similar to the October – November 2025 lapse, even if Congress ultimately enacts an extension that applies retroactively. Fortunately, because this would be the second lapse of the flexibilities, providers can look to CMS’ guidance from the prior lapse as instructive in determining how to handle telehealth claims that would not be covered under the reverted coverage framework. 

議会が2026会計年度の最終的な歳出法案に向けて動きを進める中、我々は引き続き情勢を注視し、最新情報を提供してまいります。

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, please contact the author or visit Foley’s Telemedicine & Digital Health Industry Team.