Two influential House Democrats are putting pressure on the Department of Health and Human Services (HHS) to reinstate telehealth services, accusing the administration of intentionally creating a telehealth crisis for seniors.
The two dominant political parties have pointed fingers at each other for the government shutdown, which is on its eleventh day. A new letter by Democratic health committee leaders slams Republicans for not negotiating with Democrats to prevent a shutdown and lapse of virtual care flexibilities.
HHS expanded the conditions under which Medicare providers and patients could conduct telehealth visits during the COVID-19 pandemic. The flexibilities that have been extended for years by Congress lapsed on Oct. 1 as the body failed to negotiate a government funding package.
Many providers are still offering telehealth services, Fierce Healthcare found, despite the shutdown and lack of guidance by HHS.
Frank Pallone of New Jersey and Richard Neal of Massachusetts sent the letter to Health Secretary Robert F. Kennedy Jr. and the Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D. They lambasted CMS for failing to provide guidance on virtual care before the shutdown occurred, throwing telehealth providers into uncertainty.
They urged them to provide billing guidance to providers and allow them to continue providing telehealth services during the government shutdown.
In the guidance CMS sent out on Oct. 1, it told Medicare Administrative Contractors (MACs) to hold claims for 10 business days. The Democrats said the temporary relief was the minimum required under statute.
“Instead of providing early guidance to providers and patients detailing what to expect if Congress failed to extend telehealth flexibilities, the Centers for Medicare & Medicaid Services (CMS) waited until October 1 to issue guidance to Medicare Administrative Contractors (MACs),” the letter says. “CMS then instructed MACs to implement a temporary hold on telehealth claims for 10 business days—the bare minimum under statute—even though all electronic claims are already held from processing for a 14-day minimum period under the statutory Medicare payment floor.”
CMS should have gone further, Pallone and Neal wrote, to extend the claims hold and remind providers that they have 12 months to submit Medicare claims after they provide a service.
The legislators also ask CMS to “exercise maximum regulatory and enforcement flexibility” so Medicare beneficiaries can continue to access telehealth care and hospital at home programs.
While many hospital at home programs have entered extremely complex circumstances, Medicare telehealth providers have largely had an easier path in the 11 days since the government shut down.
The majority of providers that Fierce Healthcare spoke with are continuing to provide telehealth services during the shutdown, with hopes they will be retroactively reimbursed once the government reopens.
Johns Hopkins Medicine has done more than 2.5 million telehealth visits since the onset of the COVID-19 pandemic. The online care modality accounts for about 12% of Johns Hopkins' total outpatient care volume and roughly 8% of total Medicare visits.
“We've taken a ‘hope for the best, prepare for the worst,’ approach, which I think is shared by a lot of our peers, where we hoped that the government would not shut down,” Helen Hughes, M.D., the medical director in the Office of Telemedicine at Johns Hopkins Medicine, said in an interview. “We did not stop scheduling appointments. We did not cancel appointments in advance.”
The top specialties for telehealth at the Maryland-based academic medical center are oncology, internal medicine, endocrinology, neurology, gastro, neurology and neurosurgery. For some specialties, the use of telehealth has even grown in 2025, Hughes said. For conditions that require a lot of visits, patients have enjoyed using telehealth for routine follow-ups.
“Our top priority is to maintain continuity of care for our patients, and we're hoping this is a short-lived shutdown and that the care can continue and will be retrospectively reimbursed,” Hughes said. “Many patients have waited months and months and months to see a Johns Hopkins specialist, or they have an urgent condition, and we don't want to cause a lot of operational confusion and patient stress.”
Hughes said the majority of peers that she’s spoken to are continuing virtual visits and making contingency plans for if the government remains shut down beyond a few weeks.
HealthTap, a virtual primary care company, also is seeing Medicare patients during the shutdown and assuming they will receive retroactive reimbursement.
“We continue to see patients,” HealthTap founder and CEO Sean Mehra said in an interview. “Obviously we're taking some risk about getting paid for those visits, but we believe that the risk is fairly low, and given the strong bipartisan support by both sides of the aisle, the chance that some sort of continuing resolution (C.R.) will pass either another temporary extension or a permanent reimbursement is to come, and so we're kind of financially at risk.
Mehra said that in the event the expanded telehealth flexibilities are not further extended by Congress, HealthTap could continue to offer care to Medicare beneficiaries on a cash-pay basis.
Access Telecare, another telehealth company continuing to see Medicare patients, explained that the pressure on the company grows the longer the shutdown lasts. Its customers are also starting to feel uncertain about the care modality.
“The shutdown has imposed a large degree of uncertainty, which grows with each day the shutdown continues,” Chris Gallagher, M.D., founder and chief strategy officer of Access TeleCare, wrote in an email. “For Access TeleCare we are going at risk by continuing to see Medicare patients. It is the right thing to do but is not sustainable long-term. We are in a situation where we could get upside down on our provider expenses; 60 to 70 cents of every dollar we collect goes to our providers."
He continued. “The shutdown has already impacted our clients. We have seen clients rethink strategic direction, delay contract signatures. All of this has direct impacts on patient care.”
Hughes explained that telehealth suffers a reputation hit each time the flexibilities come up against a deadline that Congress runs down to the wire.
“Each time we have one of these cliffs, especially this one that now has gone into a period of lapse, we do, I think, lose some confidence on behalf of our providers and our patients that this is a stable modality of care,” Hughes said. “And so I worry about that hit to telehealth’s reputation as a stable modality of care that the patients and providers can rely on.”