The federal government shut down at midnight on September 30 after Congress did not pass a funding bill for 2026 or a short-term resolution. While essential services like Medicare and Medicaid continue, several pandemic-era health programs and flexibilities have expired, affecting physician practices across the country.
One of the main changes is the expiration of most Medicare telehealth waivers as of October 1. This means that Medicare telehealth coverage has returned to its pre-pandemic limits, only covering patients in rural areas. Patients are no longer able to receive telehealth services from their homes, except in specific situations such as treatment for mental health or behavioral health disorders, stroke evaluation and management, and monthly visits for end-stage renal disease patients on home dialysis. The Acute Hospital Care at Home program has also ended.
Physicians providing telehealth services to fee-for-service Medicare patients now face new restrictions. Most non-rural beneficiaries are no longer eligible for telehealth visits, and audio-only services are no longer permitted. According to the Centers for Medicare & Medicaid Services (CMS), clinicians who continue offering telehealth services that are not currently payable under Medicare should consider issuing Advance Beneficiary Notices of Noncoverage to inform patients that these services may not be reimbursed.
The American Medical Association highlights an exception: “Physicians participating in certain Medicare Shared Savings Program Accountable Care Organizations may continue to provide and be paid for telehealth services under their program-specific waivers.”
Despite these changes, Medicare claim processing will continue during the shutdown. CMS has stated that physicians can still submit claims for telehealth services, but these claims will be put on a temporary payment hold while Congress decides whether to extend the waivers. If Congress acts to restore these flexibilities, payments will likely be made retroactively. However, there is no guarantee of payment if Congress does not act. The CMS newsletter suggests, “practitioners who choose to perform telehealth services that are not payable by Medicare on or after Oct. 1, 2025, may want to evaluate providing beneficiaries with an Advance Beneficiary Notice of Noncoverage.” Some physicians may also consider switching temporarily to in-person visits.
The situation remains uncertain as physician practices await further action from Congress regarding these expired flexibilities.
