Congress Passes Continuing Resolution with Some Telehealth Provisions

After a week of legislative turmoil, Congress passed and President Biden signed the "American Relief Act, 2025", a continuing resolution aimed at extending various appropriations and programs through March 31, 2025. This legislation includes numerous provisions for telehealth services but omits certain other aspects of telehealth of importance to sponsors of group health plans.

Some Telehealth Flexibilities Extended (While Others Expired)

One of the most promising provisions for many plan sponsors regarding telehealth that was widely expected to be in the final package was the extension of the telehealth relief provision which granted plan sponsors the ability to offer telehealth plans at zero cost alongside a high deductible health plan (HDHP) offering without impacting health saving account (HSA) eligibility. We noted previously that Congress would need to make this provision permanent or it would expire on December 31, 2024. Based on this legislation, the telehealth relief here will indeed sunset at the end of 2024.

Other provisions omitted from the final continuing resolution were in-home cardiology rehabilitation flexibilities as well as tax provisions for virtual diabetes prevention program suppliers in the Medicare Diabetes Prevention Program (MDPP).

One of the most notable aspects of the resolution is the extension of telehealth flexibilities under Medicare, however. These provisions, initially expanded during the COVID-19 pandemic, have been crucial in maintaining healthcare access, especially for rural and underserved communities. The resolution extends the removal of geographic requirements and expands the list of originating sites for telehealth services, allowing patients to receive care from their homes.

Additionally, the legislation continues to permit a broader range of practitioners to provide telehealth services, including physical therapists, occupational therapists, and speech-language pathologists. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will also continue to offer telehealth services, ensuring that these essential providers can maintain their expanded roles in delivering remote care.

The resolution delays the in-person visit requirements for mental health services furnished through telehealth, a move that will benefit patients needing consistent mental health support. Furthermore, the use of audio-only telehealth services is extended, providing flexibility for patients who may not have access to video technology.

Pharmacy Benefit Provisions Stripped

Another set of provisions stripped from the final package were those aimed at increasing transparency and lowering costs for pharmacy benefit manager (PBM) services. An earlier version of the appropriation package would have placed additional reporting requirements on PBMs. It would also have required 100% pass-through of prescription drug rebates, and placed other limits on the kinds of compensation PBMs are able to negotiate when obtaining drug pricing for Medicare and Medicaid programs.

Funding Extensions for Health-Related Programs

The continuing resolution also includes extensions for several key programs related to health care, employee benefits, disaster relief, and insurance. These extensions ensure that critical services and support remain available to those in need.

• Community Health Centers and National Health Service Corps: Funding for these programs is extended, supporting essential healthcare services in underserved areas.
• Special Diabetes Programs: Both the Special Diabetes Program for Type I Diabetes and the Special Diabetes Program for Indians receive continued funding, ensuring ongoing research and support for diabetes management.
• Medicare-Dependent Hospital (MDH) Program: This program, which provides additional payments to small rural hospitals, is extended, helping to sustain these vital healthcare facilities.
• Disaster Relief Programs: Various disaster relief programs receive extended funding, including those related to agricultural disaster assistance and rural development.

While the passage of the "American Relief Act, 2025" allows Congress to continue funding critical government services through the end of the Biden administration the legislation that made it over the finish line left behind many provisions that were favored by employer-sponsored health plans.