Planning for the End of Medicare's Telehealth Flexibilities

Plan as if the flexibilities end. Under section 6209 of the Consolidated Appropriations Act, 2026, Medicare's home originating site, waiver of geographic limits, expanded practitioner list, FQHC and RHC distant-site authority and audio-only coverage run through December 31, 2027, and the tele-mental-health in-person requirement starts January 1, 2028. Congress has extended these many times, but each extension has come late, and the one time it did not come on time, volume fell fast.

What happened the last time the flexibilities lapsed?

They lapsed on October 1, 2025 during the government shutdown and were restored on November 12 by Pub. L. 119-37. DEA, in the preamble to its December 2025 telemedicine rule (90 FR 61301), cited an analysis by researchers at Brown University's School of Public Health finding a 24 percent drop in fee-for-service telemedicine visits in the first 17 days after the lapse, and drops of nearly 40 percent or more in states including Florida, Louisiana, Washington, Tennessee, Maryland, Oklahoma and New York. Practices that had a plan kept seeing patients. Practices without one canceled appointments, then rebooked them.

What would change on January 1, 2028 without another extension?

• Location. For most services, the patient would again need to be at a qualifying originating site, such as a physician office or hospital, in a rural area as section 1834(m)(4)(C) defines it. Home visits would not qualify.
• Who can bill. The practitioner list would revert to those in section 1842(b)(18)(C). Physical therapists, occupational therapists, speech-language pathologists and audiologists would drop off.
• Audio-only would be limited again, with behavioral health the main exception.
• FQHCs and RHCs would lose the general distant-site authority.
• Tele-mental health keeps a home pathway under section 1834(m)(7), but practitioners would need an in-person visit within six months before the first telehealth service and, under CMS's rule at 42 CFR 410.78(b)(3)(xiv), at least every 12 months after, with documented exceptions. See the in-person requirement.

Step 1: How much revenue is exposed?

Pull 12 months of Medicare telehealth claims and split them four ways: mental health or substance use disorder services (pathway continues), everything else by video, everything else audio-only, and services by practitioner types that lose eligibility. The last three are your exposure. For most primary care and specialty practices, the number is smaller than feared. For a therapy practice built on PT or speech telehealth, it is most of the Medicare book.

Step 2: Which patients go where?

Assign every active Medicare telehealth patient one of four paths: continue by telehealth (behavioral health, or a qualifying rural originating site); convert to in-person at your site; convert to in-person at a partner site; or move to a non-telehealth service that Medicare pays regardless of location, such as remote patient monitoring or virtual check-ins, where clinically appropriate. Remote monitoring has its own rules and a pending 2027 proposal on staffing; see the 2027 fee schedule proposals.

Step 3: Do you have the in-person capacity?

For behavioral health, the January 1, 2028 in-person requirement is the bigger operational problem than the cliff itself. Count the patients who have never been seen in person by their treating clinician, then count the clinic hours you have. If the math does not work, look at whether the rule's same-specialty, same-group provision helps: CMS allows another practitioner of the same specialty and subspecialty in the same group to furnish the in-person service when the treating practitioner is not available.

Step 4: What do you tell patients, and when?

Write two letters now. One says nothing has changed and names the date. The other tells the patient what their next visit will look like if the rules change. Medicare patients who were mid-treatment in October 2025 got neither, and many simply stopped coming.

Step 5: When do you decide?

Set three dates: a mid-2027 checkpoint when Congress's year-end health package starts taking shape, an October 1, 2027 decision on scheduling January visits, and a December 1 trigger to send the second letter. Assign one person to own them. Put Medicare Advantage on the same calendar: MA plans set their own telehealth benefits under 42 CFR 422.135, which can differ from traditional Medicare's limits, so the plan may differ for an MA patient.

What should you not do?

• Do not stop seeing Medicare patients by telehealth early. Services furnished through December 31, 2027 are covered under the extension.
• Do not tell patients telehealth is going away for good. It may be extended again; the CONNECT for Health Act (S. 1261 / H.R. 4206) is pending.
• Do not assume DEA rules move with Medicare. They are separate; see the DEA timeline.

Our Medicare 2027 Cliff Plan ($1,450) runs these five steps with your data and hands you the letters, the patient sort and the calendar. The dates are tracked on the Medicare telehealth hub and summarized in what the 2026 spending law extended. If your clinicians need Medicare enrollment updates for new practice locations, White Glove Credentialing handles PECOS.