CMS Restores Medicare Telehealth Flexibilities Post-Federal Shutdown through Jan 2026

The Centers for Medicare and Medicaid Services (CMS) has issued updated guidance regarding Medicare telehealth claims affected by the recent federal government shutdown. CMS confirmed that all Medicare telehealth waivers and flexibilities, which had lapsed during the shutdown, are now retroactively restored for services rendered from October 1, 2025, through January 30, 2026. This means telehealth claims during this period will be processed as if no interruption occurred. Key waivers that had temporarily expired included suspension of geographic and originating site restrictions, which previously allowed beneficiaries to receive telehealth services from any location, including their homes. During the shutdown, Medicare Administrative Contractors (MACs) were instructed to hold or return claims they could not approve under pre-waiver rules. Now, with CMS reinstating these flexibilities retroactively, MACs have been directed to process all pending or returned telehealth claims for the affected period. CMS further clarified that Medicare beneficiaries may continue accessing telehealth services from any site through January 30, 2026, supporting continuity of care for both rural and non-rural patients. Providers are instructed to resubmit any returned telehealth claims initially held due to the lapse. Additionally, CMS recommended that providers identify patients who paid out-of-pocket during the shutdown for now-covered telehealth services and refund any overpayments once claims are processed. This guidance aims to stabilize telehealth billing operations and reimbursement amidst federal disruptions. The California Medical Association (CMA) is monitoring CMS’s implementation of these restored flexibilities and continues advocating for policies that support telehealth access for Medicare recipients and healthcare providers in California. This restoration aligns with broader Medicare priorities to maintain expanded telehealth coverage established during prior public health emergencies. It underscores the regulatory challenges and administrative complexities caused by federal government shutdowns on healthcare delivery and payment processes. The situation highlights the critical role of CMS and MACs in navigating rapid policy reversals and ensuring providers receive timely reimbursements for telehealth services rendered under evolving rules. Stakeholders in the Medicare telehealth ecosystem should remain vigilant about claim submission guidelines, compliance requirements, and potential refunds related to this retroactive restoration. This development stresses the ongoing importance of telehealth within Medicare’s benefit design and provider payment frameworks, particularly in adapting to unforeseen federal administrative events.