News Archive

"While this latest development is a relief, it is clear that the issues surrounding the funding of Medicare telehealth -- and telemedicine prescribing -- are not going away every time Congress kicks the proverbial can down the road.... In 2025, we know the consequences of letting the flexibilities expire -- providers do not get paid, access to quality care is diminished, and questions of retroactive payment create uncertainty."  MORE >>

"[On] October 21, 2025, CMS ... [directed] MACs to lift the claims hold for Medicare physician fee schedule, ground ambulance transport and federally qualified health center claims, including telehealth claims that 'CMS can confirm are definitively for behavioral and mental health services.' ... CMS directed MACs to continue to temporarily hold claims for nonbehavioral and mental health services telehealth claims and for acute hospital care at home claims."  MORE >>

"With the PHE-era federal waivers expected to end on December 31, 2025, and state laws increasingly diverging from these PHE-era exceptions, the legal framework for telehealth and tele-prescribing is entering a period of rapid change and heightened complexity."  MORE >>

"The OBBBA contains a number of provisions that impact employee benefit matters, including changes to: [1] controlled group application to the limits to deductibility of certain compensation in excess of $1 million, [2] health savings accounts, [3] dependent care assistance plans, [4] 529 savings accounts, [5] ABLE accounts, [6] new Trump savings accounts, [7] transportation fringe benefits, [8] employer payments of students loans, [9] paid family and medical leave credit for the employer, [10] moving expenses and [11] Federal student loan changes[.]"  MORE >>

"[T]he OBBBA does include some new benefit enhancement options for employee benefit plan sponsors, including provisions related to health savings accounts (HSAs), dependent care assistance programs (DCAPs), student loan repayment assistance, and the creation of 'Trump accounts' designed to increase savings for children. With the exception of the pre-deductible telehealth services safe harbor (effective January 1, 2025), the changes are effective for tax years after December 31, 2025[.]"  MORE >>

"Mental health conditions remained the top diagnostic category for patients with a telehealth claim nationally and in every region. Nationally, patients diagnosed with mental health conditions accounted for 63.0 percent of patients with a telehealth claim in April, up from 61.6 percent in March.... As in March, in April 2025, the age groups 19-30 and 31-40 accounted for the largest percentages of patients with a telehealth claim nationally and in every region."  MORE >>

"After having been left out of the initial House bill, the Act includes the long-awaited telehealth extension.... Although employees may want to take advantage of the increase in the DCAP contribution limit, employers should continue to run and monitor DCAP nondiscrimination testing ... Employers that want to offer [Trump Account] contributions to their employees will need a formal plan document and will need to comply with certain nondiscrimination testing rules."  MORE >>

"Health and welfare provisions in the law include: [1] Reinstatement and permanent relief for telehealth services covered by HSA-qualifying HDHPs before the deductible is met.... [2] Favorable HSA treatment for ... Direct Primary Care Service Arrangements.... [3] Permanence of employer tax-free payments up to $5,250 (indexed) for employees' qualified student loans.... [4] Permanence and enhancement of employer tax credit for Paid Family and Medical Leave.... [5] Higher income exclusion for dependent care assistance programs.... [6] Enhancement of employer-provided childcare tax credit.... [7] Enhancement of adoption assistance tax credit.... [8] Permanence of elimination of tax-free bicycle commuting reimbursements."  MORE >>

"The final OBBB does not change or eliminate any tax incentives for employer-provided health coverage or retirement savings plans.... [P]rovisions related to PBMs were removed from the final bill that was signed into law.... The final version of the OBBB did not include any significant changes regarding retirement plans."  MORE >>

"[1] For HDHP/HSA with 2025 plans years, decide whether to continue to charge FMV for telehealth services received prior to satisfaction of the deductible or pivot and reimburse telehealth FMV charges incurred for the 2025 plan year. [2] Work with the FSA vendor to implement the increase in dependent care FSA limits for the 2026 tax year and communicate the increased limit to employees during 2026 open enrollment. [3] Consider whether to make any employee benefit plan changes in 2026 to take advantage of OBBB changes regarding tax-free employer student loan payments under educational assistance programs and employer contributions to the Trump Accounts."  MORE >>

"The OBBB permanently expands HSA eligibility (including for telehealth and direct primary care), raises the Dependent Care FSA limit to $7,500, and introduces 'Trump Accounts' to support long-term savings for children.... Student loan repayment assistance is now a permanent, tax-free benefit with inflation indexing starting in 2027, while the tax-free bicycle commuting reimbursement has been permanently repealed."  MORE >>

"Among adolescents who received mental health treatment in the past 12 months, 45.3% received some care via telehealth.... High use of telehealth for mental health treatment for adolescents was concentrated in office-based specialty care."  MORE >>

"The legislation, which goes into effect on September 1, 2025, requires that health insurance plans provide coverage for healthcare and dental services delivered through telemedicine to the same extent as if the services were provided through in-person consultations."  MORE >>

"Telehealth companies selling compounded drugs are making modest inroads into the market for popular weight loss drugs that big pharma spent decades and billions of dollars to develop and bring to market. The compounded products, with fewer barriers to entry, are reaching a broader consumer market than U.S. Food and Drug Administration (FDA)-approved glucagon-like peptide-1 (GLP-1) products, and at least one brand pharma player -- Eli Lilly and Company (Lilly) -- is turning the courts to reverse the trend."  MORE >>

"How do plan employers and plan sponsors factor into this evolving and developing landscape? To maximize investment in virtual care solutions and to guide choices, they may want to establish and/or refresh their virtual care strategy annually. From there, vendor partners can be identified that best support the strategy. The last piece of the puzzle is a solid measurement program that tracks results and evaluates outcomes."  MORE >>

"Effective January 1, 2025, the special COVID-era rule under the CARES Act that allowed employers sponsoring high-deductible health plans to provide free telehealth visits without affecting employees’ eligibility to contribute to health savings accounts (HSA) has expired. Employers must now either ensure that telehealth services are preventive or subject to the plan’s deductible, or they must charge for such services in order to maintain HSA eligibility for their employees."  MORE >>

"By the end of 2026, 25-30% of all medical visits in the United States will be conducted via telemedicine. Although the adoption rate of telemedicine has been low in 2024, it will grow considerably with regulatory support from the US Congress."  MORE >>

"Nationally, telehealth utilization rose by 6.13 percent, from 4.74 percent in July to 5.04 percent in December. From July to December 2024, mental health conditions ranked as the number one telehealth diagnostic category nationally ... In the Midwest, the top five diagnostic categories from July to December 2024 included two categories not found at the national level: substance use disorders and sleep disorders."  MORE >>

"On February 27, 2025, a group of more than 300 employers, insurance industry professionals, and others sent a letter to the majority and minority leaders in Congress, asking them to restore and make permanent the safe harbor. On the same day, a bipartisan bill was introduced in the House and the Senate (HR 1650 and S 763). The bill would make the telehealth exception permanent and would be effective for plans beginning on or after January 1, 2025."  MORE >>

"Nationally, telehealth claim lines increased from 4.82 percent of medical claim lines to 5.04 percent, a 4.5 percent increase. In the Midwest, the increase was 5.6 percent; in the Northeast it was 3.1 percent; and in the South it was 4.7 percent. In the West, however, telehealth claim lines decreased by 0.9 percent. The data represent the commercially insured population, excluding Medicare Fee-for-Service, Medicare Advantage and Medicaid."  MORE >>

"The funding patch contains limited healthcare extenders and funding. It extends telehealth flexibilities for Medicare beneficiaries and providers, which will allow telehealth visits to be conducted from an expanded list of locations, including the patient's home, and will allow an expanded list of provider types to furnish telehealth."  MORE >>

"If the waivers expire, commercial payors ... could continue to offer reimbursement for telehealth services beyond what Medicare fee-for-service covers.... Providers may also continue to offer non-covered telehealth services to Medicare Fee-For-Service beneficiaries on a cash-pay basis, though any provider offering this opportunity would need to comply with Medicare notice and eligibility requirements as well as state law."  MORE >>

"The Senate Democrats' package would give lawmakers room to breathe on telehealth, moving the expiration date of pandemic-era flexibilities to Dec. 31, 2026 ... The package also revives a private insurance telehealth provision that Congress let lapse at the end of 2024, the ability for patients with high deductible health plans linked to health savings account to receive telehealth services pre-deductible."  MORE >>

"Without passing additional legislation, current Medicare telehealth flexibilities will expire on March 31, 2025.... With the March 31st deadline fast approaching, key organizations ... are working overtime to raise awareness of the pending deadline and ensuring telehealth remains accessible and viable for both patients and providers."  MORE >>

"Right before the New Year, Congress extended Medicare's telehealth flexibilities for three months ... until March 31. While this move averts an immediate crisis, it fails to address telehealth's long-term uncertainty. These temporary solutions undermine the full potential of telehealth, leaving providers in limbo and patients at risk of losing critical access to care. With permanent policy reform, Congress can unlock telehealth's full clinical and financial potential."  MORE >>