What You Should Know
– The AMA is urging Congress to pass permanent authorization of Medicare telehealth services before the current waiver expires on January 30, 2026.
– This advocacy follows a “tumultuous” 2025 in which a 43-day government shutdown caused a 24% national drop in fee-for-service telemedicine visits, demonstrating the extreme sensitivity of patient access to legislative lapses.
The Economic Battle: Challenging CBO Scoring
The crux of the AMA’s issue brief is a call for the Congressional Budget Office (CBO) to modernize how it calculates the cost of telehealth.
- Current Limitations: CBO scoring relies heavily on historical data and assumes virtual care mostly adds to total service volume rather than substituting for costlier in-person care.
- The AMA Advocacy: They are demanding a “robust analysis” that factors in long-term savings from early intervention and reduced hospital readmissions—metrics currently missing from budgetary estimates.
- Evidence-Based Substitution: Real-world data shows telehealth can drive higher appointment completion rates and produce systemic efficiencies.
“Since the COVID-19 public health emergency, Congress has repeatedly extended telehealth flexibilities for Medicare patients—often at the last moment—creating uncertainty for millions of patients and their physicians,” said AMA President Bobby Mukkamala, M.D. “As the current waiver deadline approaches, Congress must finally act decisively to prevent a disruptive and abrupt halt to the expanded telehealth services that have improved care continuity, chronic disease management, and access for rural and underserved communities.”
The Post-Shutdown Crisis: A 2025 Retrospective
The AMA points to the 2025 government shutdown as a “stress test” that the system failed.
- Utilization Drop: When waivers briefly expired in October 2025, virtual care visits plunged 24% for traditional Medicare beneficiaries and 13% for Medicare Advantage.
- Geographic Sensitivity: Several states saw declines exceeding 40%, particularly in non-rural areas that had come to rely on the temporary “originating site” flexibilities.
- Retroactive Relief: While Congress eventually reinstated coverage retroactively through January 30, 2026, the AMA argues this “last moment” cycle creates dangerous uncertainty for chronic disease management.
Next Steps for HIT Leaders
- Audit Dependence: Identify which service lines rely on the “non-rural” originating site waiver.
- Plan In-Person Touchpoints: Behavioral health workflows should prepare for the return of the 6-month in-person visit requirement if the waiver lapses.
- Advocate: Align with the AMA’s push for the Telehealth Modernization Act (S. 2709/H.R. 5081) to extend flexibilities through at least 2027.
