Congress approved extensions to Medicare telehealth flexibilities and the Acute Hospital Care at Home waivers as part of the Consolidated Appropriations Act, 2026 (H.R. 7148), which President Trump signed into law on February 3, 2026. This followed a brief partial government shutdown that caused a temporary lapse in these provisions starting January 31, 2026, but the extensions are retroactive, restoring continuity.
The five-bill minibus brings an end to the three-day government shutdown and reinstates key telehealth flexibilities for multiple years. This legislative package includes several critical telehealth provisions, including:
– – Extension of Medicare telehealth flexibilities through December 31, 2027
– – Five-year extension of the Acute Hospital Care at Home Program through September 30, 2030
– – Extension of in-home cardiopulmonary rehabilitation flexibilities through January 1, 2028
– – A requirement that HHS issue guidance within one year on furnishing telehealth services to individuals with limited English proficiency
– – Inclusion of virtual diabetes suppliers in the Medicare Diabetes Prevention Program through December 31, 2029
In the landscape of U.S. healthcare policy, Medicare’s framework for telehealth services – defined as the provision of medical care through telecommunications technologies such as video conferencing or telephone consultations – has historically been constrained to mitigate risks of overuse and ensure quality. Prior to the COVID-19 pandemic, eligibility was limited to patients in rural locales, required physical presence at designated originating sites like clinics or hospitals, and mandated real-time audio-video interactions, excluding home-based services and restricting reimbursement to a narrow cadre of providers. This conservative stance mirrored an era of nascent technology adoption and fiscal prudence.
The onset of the pandemic in 2020 catalyzed a paradigm shift. Enacted through emergency legislation including the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES Act in March 2020, Medicare introduced sweeping telehealth flexibilities. These reforms eliminated geographic restrictions, enabling nationwide access from patients’ homes; incorporated audio-only modalities for those with limited broadband; broadened the scope of reimbursable practitioners to encompass therapists, counselors, and allied health professionals; and covered an expanded array of services, from mental health evaluations to chronic disease management.
Concurrently, the Centers for Medicare & Medicaid Services (CMS) initiated the Acute Hospital Care at Home waivers in November 2020, authorizing select hospitals to administer inpatient-acute care – encompassing intravenous therapies, respiratory support, and post-operative monitoring – in patients’ residences, subject to rigorous protocols including daily in-person assessments and continuous virtual oversight. These measures addressed acute capacity strains and infection control imperatives during peak crisis periods.
As the public health emergency concluded on May 11, 2023, the enduring value of these innovations became evident. Empirical data highlighted enhanced patient access, reduced operational costs, and elevated satisfaction metrics, prompting congressional extensions. The Consolidated Appropriations Act of 2023 prolonged telehealth flexibilities until December 31, 2024, while hospital-at-home waivers received incremental renewals: a two-year extension in 2022, followed by 90-day and subsequent bridges to September 30, 2025. Industry stakeholders, including the American Medical Association and American Telemedicine Association, advocated vigorously for permanence, citing demographic trends such as population aging and persistent rural-urban disparities in care delivery.