Home health agencies and their patients are set to wake up on Wednesday to a new world without critical telehealth flexibilities. 

Currently, home health agencies are permitted to use telehealth for home health face-to-face encounters, a flexibility that a series of short-term extensions have perpetuated. With a government shutdown looming, this ability could lapse unless lawmakers issue an extension before the shutdown. Also at stake is the hospital-at-home waiver, which could expire on the same day. 

If the government shuts down without the telehealth flexibilities extended, patients will “lose,” according to Kyle Zebley, senior vice president of public policy at The American Telemedicine Association, an advocacy organization focused on advancing telehealth, and executive director of ATA Action.

“Millions of Medicare patients will go to sleep on Tuesday with access to telehealth coverage and wake up on Wednesday having lost it,” Zebley told Home Health Care News. “They’ll have had a benefit for five and a half years that takes appropriate advantage of where technology is now when they go to bed Tuesday, and they’ll no longer have it Wednesday.”

For home health agencies specifically, this could limit the pool of patients they accept, hinder patient care and add expensive back-office burden.

“To be eligible for CMS reimbursement for home health, you have to have a face-to-face visit with your doctor or nurse practitioner within 90 days before you start home health, or within 30 days after,” Sherry Kesler, Senior Director of Sentara Home Health Services, told HHCN. “Currently, you can do that virtually. That’s considered a face-to-face. If they eliminate that, that is going to decrease [eligibility] for a lot of patients, especially home health. They’re homebound. That virtual care component for homebound patients really helped meet that need, because some of these patients have to call an ambulance to get to a doctor.”

Sentara Home Care Services offers skilled nursing care, hospice and infusion therapy, among other services. It is the home-based care arm of Sentara Health, a not-for-profit health care system headquartered in Hampton Roads, Virginia.

Without the ability to have a virtual appointment as an acceptable form of a face-to-face visit, home health providers cannot bill for services, Kesler said. Home health agencies are therefore not likely to accept patients who have not had an in-person visit within the last 90 days.

The patients most at risk are those in rural or transportation-limited areas, according to Dr. Madeline Sterling, internist at Weill Cornell Medicine, who has conducted research regarding telehealth and home health. Additionally, providers could face added complications and potential expenses if the current regulation expires.

“For agencies, some have relied on telehealth to provide timely face-to-face encounters to offset nursing (or other home care clinician) shortages,” Sterling told HHCN in an email. “Without it, visits may occur less quickly for patients. They are also likely to incur more administrative and billing challenges, as well as losing referrals.”

The likely scenarios

Stakeholders expressed a sense of urgency regarding the telehealth flexibility rapidly approaching the expiration date. While many of the likely scenarios involve at least a temporary lapse in the flexibility, it is not due to a lack of lawmaker support for the broadly popular regulations.

“There is a real risk of a ‘telehealth policy cliff’ if Congress does not pass further legislation before Oct. 1, 2025, to make the current telehealth flexibilities permanent,” Sterling said. “However, there has generally been bipartisan support for them, so we may see that here now if lawmakers will grant a short-term extension (like it has previously) to extend telehealth use.”

The political consensus regarding the flexibilities is “stunning,” Zebley said. The problem, he said, is the history of short-term extensions, which he likened to the movie Groundhog Day. A history of short-term extensions has now created a most likely scenario that is also among the worst-case scenarios.

“Despite our broad-based bipartisan support, despite the administration saying up and down how supportive they are, despite the fact that there is no opponent, Congress is so dysfunctional, the federal government is so incapable of acting, that we are going to be a victim of that dysfunction,” he said. “Our critical priorities that benefit millions of patients are going to lapse. They’ll have lapsed for the first time since the beginning of the decade. They will lapse at a time when the health care system is not, as it is, adequately serving people.”

Such a lapse would exacerbate systemic issues within the U.S. health care system, he said.

The even worse case scenario, which Zebley said is unlikely, is that the telehealth flexibility is forgotten altogether and not included in the next funding bill.

The broader picture

The current risks to crucial home health regulations are a consequence of larger political issues, experts told HHCN, but they could echo throughout the health care continuum.

Home care provider Senior Helpers has witnessed the benefits of the telehealth flexibility, Peter Ross, CEO and co-founder, told HHCN. Senior Helpers currently facilitates telehealth visits for its clients, but Ross said the company is prepared to transport their clients to doctors’ appointments if telehealth access is at risk.

“We’ve done that for 20 plus years, so that’s not going to change,” Ross said. “My impetus on this particular topic is to advocate for the family and the provider.”

Maryland-based Senior Helpers is a home care company that operates over 380 franchise locations in the U.S., Canada and Australia, owned by Waud Capital.

The telehealth flexibility will not be extended without being attached to a government funding bill, Zebley said. The HaH waiver is also likely to be extended as part of a package with a government funding bill, although it is possible that it could be passed separately. 

Without inclusion in a bill that would fund the government past Tuesday, patients will be sent to more costly care options when their conditions deteriorate.

“It’s really important to keep on the radar that if the providers’ ability to bill for virtual care is eliminated, readmission rates will go up,” Kesler said. “The capacity to see a provider virtually, within 24 hours, is incredible. When we have a declining patient in home health, if we can’t get them seen quickly enough, we’re sending them to the ER. So we are trying to figure out ways that we’re going to overcome that, if that ability’s taken away.”

Without a clear plan to fund the government beyond Tuesday, the window to safeguard the continuation of this flexibility is rapidly closing.

“The clock is ticking,” Sterling said.