Article Reference Code: 10.17.2025
Written by: Christine Hall
When the government shuts down, it’s not just national parks and passport offices that feel the pinch; it’s also your webcam, your telehealth platform, and the patients who depend on virtual access to care.
As of October 1, 2025, Congress failed to pass a Continuing Resolution (CR) to extend government funding, which included the temporary Medicare telehealth flexibilities that so many providers and patients have relied on since the COVID-19 era.
Let’s unpack what this means, who it affects, and what stays alive (hint: behavioral health is hanging in there).
What Actually Happened? A government shutdown occurs when Congress doesn’t pass a funding bill or CR to keep federal operations running. Medicare itself doesn’t shut down; claims processing, Part A and B payments, and essential operations are considered “mandatory spending.”
Unfortunately, the Telehealth flexibilities (for example, the patient’s home as an allowed place of service) are not permanent law. They’ve been temporarily extended through a patchwork of CRs and budget bills since 2020. When those “extensions” lapse, so do many of the legal authorities that let telehealth function the way it has for the past few years.
The “Flexibilities” That Changed Everything
Now you may be thinking, what ARE these flexibilities you are speaking of, especially if your career started during or after COVID? During the COVID-19 Public Health Emergency (PHE), from March 1, 2020, to May 11, 2023, Congress and CMS temporarily lifted longstanding barriers that made telehealth almost impossible for many patients.
Here’s what those flexibilities included:
- Geographic and originating site restrictions were waived. Patients could receive care from anywhere, including their homes, not just from designated rural sites.
- More provider types were allowed to bill for telehealth, including physical therapists, occupational therapists, and FQHCs/RHCs as distant sites.
- Audio-only visits became permissible for certain services, a lifeline for patients without internet or smartphones.
- Behavioral and mental health visits gained expanded access, removing the requirement for an in-person visit before telehealth treatment.
- Hospital-at-Home programs let hospitals deliver inpatient-level care in the patient’s home.
Congress extended these flexibilities several times, but they’ve always been tied to temporary funding legislation, the legislative equivalent of a Band-Aid over a deep policy wound.
With the CR now expired, we’re staring at what many call “the telehealth cliff.”
Telehealth vs. Virtual Care vs. Behavioral Health: Why the Distinctions Matter
Before diving into the fallout, it’s important to distinguish these three often-confused terms:
- Telehealth (Medicare definition) – Refers to specific services delivered via telecommunications that meet CMS requirements — eligible provider types, service codes, technology (usually real-time video), and geographic/originating site rules.
- Virtual Care – A broader umbrella term that includes digital health tools, asynchronous visits (like virtual check-in or portal messages), remote patient monitoring, and virtual check-ins. These services can still exist even if Medicare’s “telehealth” authority narrows, but coverage and reimbursement depend on each payer’s policy.
- Behavioral & Mental Health Telehealth – Here’s where there’s a glimmer of hope.
In 2022, Congress made behavioral and mental health telehealth coverage permanent under Medicare, without geographic restrictions and with continued permission for some audio-only visits.
What About Virtual Care? Good question, and a crucial one for compliance teams. Because “virtual care” includes things like remote monitoring, asynchronous consultations, and virtual check-ins, those aren’t directly impacted by the CR lapse.
Unlike general telehealth, behavioral and mental health telehealth services received permanent coverage through earlier legislation.
This includes:
- No geographic or originating site restrictions.
- Audio-only permitted in select cases.
- Continued allowance for home-based visits.
However, CMS has emphasized that documentation and modality standards still apply.
Providers must document the clinical appropriateness of tele-mental health, maintain HIPAA-compliant technology, and meet time and medical necessity requirements, all of which remain fair game for audit.
What Providers Should Do Now
- Review Your Telehealth Services – Identify which services you’ve been billing under the expanded rules. If they rely on home-based or audio-only delivery, they may now be non-billable under Medicare.
- Create a “Telehealth Whitelist” – Map out what’s still compliant and what must revert to in-person care. Use a tracking tool or spreadsheet to monitor payer-specific rules (since commercial and Medicare Advantage plans may differ).
- Communicate Clearly with Patients – If there’s a chance a service won’t be covered, use Advance Beneficiary Notices (ABNs). Medicare won’t allow them to be used retroactively, so you’ll want to get them signed before any gray-area telehealth services are rendered.
- Audit Your Documentation – Keep detailed notes on why telehealth was medically necessary and which platform was used (audio-only, video, etc.). This is your best defense if claims are reviewed later.
- Prepare Contingency Plans – Some organizations may temporarily suspend certain telehealth services or transition them to hybrid or in-person formats until Congress acts. Others may continue services “at risk”, holding claims in hope for retroactive reimbursement, but that’s a calculated gamble.
What This Means for Payers and Health Systems
Payers, including Medicare Advantage plans, often follow CMS policy. Expect them to:
- Tighten telehealth coverage rules.
- Revisit network agreements and pricing.
- Require updated documentation or preauthorization for certain telehealth encounters.
Looking ahead, a common question is whether Congress will fix telehealth. The answer is, probably, eventually. Historically, lawmakers make permanent change through bipartisan votes, often retroactively restoring reimbursement for services rendered during lapses.
But “probably” isn’t a compliance strategy. Providers should plan for the current restrictions to remain until Congress acts. And with election-year politics heating up, quick action isn’t guaranteed.
In the meantime, industry groups like the American Medical Association (AMA), American Telehealth Association (ATA), and NAMAS are urging Congress to pass the CONNECT for Health Act (S. 1261/H.R. 4189) and the Telehealth Modernization Act (H.R. 7623), both aimed at making telehealth flexibilities permanent.
Christine’s Takeaway
Telehealth’s policy life cycle has become a rollercoaster, rising with every public health extension and falling with every funding lapse.
My advice to you all is to stay adaptable. Audit proactively. And keep your compliance seatbelt fastened until Congress decides to stabilize the ride.
Telehealth isn’t disappearing, it’s evolving. But without consistent legislative support, providers will need to balance innovation with vigilance to ensure access, compliance, and reimbursement all move in the same direction.
About the author or to connect with questions or comments click below:
Christine Hall, BSHM, CHC, CDEO, CPC, CPB, CPMA, CRC, CPC-I, CPA-TH
Christine Hall is a nationally recognized healthcare compliance consultant and educator with over 30 years of experience in health administration, revenue cycle management, and medical coding. She holds a Bachelor of Science in Healthcare Management with a minor in Sociology and is currently pursuing her Master’s degree in Healthcare Law at Florida State University.
