New final rules show how federal policy is evolving on health IT
WEDI analysis shows the impact that changes in the Medicare physician fee schedule will have on the use of technology.
Fee schedules have all kinds of crucial information that affect the healthcare industry. Generally, people’s attention gravitates to the dollars and cents, but other important nuggets are buried in the weeds, showing how federal policy will impact those delivering care.
Earlier this month, the Centers for Medicare & Medicaid Services (CMS) announced policy changes that would affect care delivery in its final rule outlining changes to its 2026 Medicare physician fee schedule.
An analysis by WEDI highlighted how the new schedule – to go into effect on January 1 – would have implications regarding healthcare IT and other uses of technology. The agency’s final rule was made available for public inspection recently in the Federal Register.
The CMS rule also includes changes to Part B payment and coverage policies, Medicare shared savings program requirements and the Medicare prescription drug inflation rebate program.
The specific changes related to healthcare IT are likely to have important impacts on care delivery and show the direction that future federal policies will take.
And, with the long-awaited ending of the shutdown of the federal government, there’s calls for long-term federal policy support for these programs to be codified and made permanent.
Telehealth services
WEDI’s analysis suggests that a streamlined process for adding services to the Medicare Telehealth Services list has been completed. “The distinction between provisional and permanent services and is being removed, and the focus of reviews will be on whether the service can be furnished using an interactive, two-way audio-video telecommunications system.”
In addition, limitations related to follow-up inpatient visits, follow-up nursing facility visits and critical care consultations have been removed. Another provision permanently adopts a provision that enables supervising practitioners to provide supervision through real-time audio and visual interactive telecommunications.
Also made permanent is an allowance for teaching physicians to have a virtual presence in all teaching settings, but only in clinical instances when a service is provided virtually.
Rural health clinics, FQHCs
CMS also made clarifications in new policies regarding rural health clinics (RHCs) and federally qualified health centers (FQHCs).
Like the rules involving telehealth services, the same definition of direct supervision applied to telehealth services will be applied to RHC and FQHC services that require direct supervision.
Additionally, the rule includes an extension, through Dec. 31, 2026, of an allowance for non-behavioral health visits furnished by telecommunication technology for RHC and FQHC services using telecommunication technology, including services provided by audio-only telecommunication technology.
Changes in the Medicare Shared Savings Program
Accountable care organizations (ACOs) get some breaks and adjustments under the new final rules.
Newer, less experienced plans will have a shorter timeframe before they can qualify for higher levels of risk and potential reward, but they will face pressure to progress more rapidly, WEDI notes. The current maximum of seven performance years is being cut to five for ACOs identified as inexperienced with performance-based risk Medicare ACO initiatives.
Cyberattacks, including ransomware and malware, are being added to the quality and finance extreme and uncontrollable circumstance policies under the Shared Savings Program, starting for performance year 2025 and beyond.
Finally, the Shared Savings Program quality reporting monitoring requirements are being revised for performance years beginning on or after January 1, and ACOs will be monitored for their adherence to the alternative quality performance standard.
Other changes in the shared savings program and deeper explanations can be found here.
Post-shutdown responses
Meanwhile, there’s relief among some industry segments after the nation’s longest shutdown has ended, thus enabling the restoration of Medicare coverage for telehealth services and the Acute Hospital Care at Home program.
For at least the near term, coverage will be continued, according to ATA Action, an affiliated trade organization of the American Telemedicine Association. But the advocacy group is pushing for longer-term assurances of those programs.
“We are grateful to Congress and President Trump for swiftly passing critical legislation last night that extended the Medicare telehealth waivers and Acute Hospital at Home program through Jan. 30, 2026, and allows retroactive payment for these services since the temporary waivers lapsed on October 1,” says Kyle Zebley, executive director of ATA Action and senior vice president of public policy, the ATA.
“These are provisions we have been fighting for and mark an important milestone for the entire healthcare community,” he added.
“That said, we are doubling down on our efforts to work with Congress and the Administration to secure a permanent solution — or at minimum a years-long extension — for these telehealth waivers. We cannot continue to subject patients across the nation, in rural and urban communities, managing chronic and acute conditions, to ongoing uncertainty about their care,” Zebley said. “And with January 30 fast approaching … swift action is essential.”