How to Build a Telehealth Program on Temporary Rules
Much of Medicare telehealth still runs on short term extensions. Practices that plan for several policy outcomes will keep virtual care stable no matter how Congress acts.
Few physicians expected that pandemic era telehealth rules would still be running on short extensions years later. Yet that is the reality for much of Medicare virtual care. Flexibilities that let patients be seen at home, in any geographic area, and by audio only in some cases have been renewed by Congress repeatedly, often at the last minute. Practices have built workflows on rules that could change with the next deadline.
Where the Uncertainty Lives
Before the public health emergency, Medicare telehealth was tightly limited, largely to rural patients seen at designated originating sites. The emergency waived those limits, and Congress has since extended many of them in short increments. Some changes, particularly for behavioral health, have been made more durable. Others remain temporary.
Controlled substance prescribing by telemedicine is a separate track governed by the DEA, which has also relied on extensions while it works on permanent rules. Commercial payers and Medicaid programs set their own policies, which vary by plan and by state. State licensure adds another layer, since physicians generally need to be licensed where the patient is located, though interstate compacts have made multistate licensure easier.
The Policy Debate
Supporters of permanent expansion point to patient convenience, better access for people with mobility or transportation barriers, and continuity for behavioral health. Skeptics, including some budget analysts and fraud investigators, worry about added spending, low value visits, and billing abuse. There are also open questions about quality in some virtual encounters and about how audio only care should be paid. Lawmakers of both parties have generally supported telehealth, but cost scoring and program integrity concerns have slowed permanent action.
A virtual care program that only works under one set of rules is a program waiting for a deadline to break it.
Planning for Any Outcome
- Map your telehealth volume by payer so you know exactly which patients depend on temporary Medicare flexibilities.
- Keep an in person fallback workflow ready for visit types that could lose coverage.
- Document clinical rationale for audio only visits, since this is an area of ongoing scrutiny.
- Track state licensure for patients who travel or live across state lines.
- Review controlled substance prescribing protocols against the current DEA rules, not the rules you learned in 2020.
- Assign one person to watch for extension deadlines and brief the practice before each one.
Telehealth is almost certainly here to stay in some form. The practices that will be best positioned are the ones that treat each extension as a planning window rather than a reason to stop planning.
Marcus Bell covers health policy, reimbursement, and regulation for The Script Pad.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
