Legislative Actions and Updates
An overview of the latest policy changes and updates impacting digital health.
Understanding the CY 2026 CMS Physician Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) has released the Calendar Year (CY) 2026 Physician Fee Schedule (PFS) proposed rule, outlining significant potential changes to how physicians and other healthcare professionals are reimbursed for services provided to Medicare beneficiaries. This annual rulemaking process is critical for the healthcare community, and this year's proposal contains key provisions that will directly impact the delivery and expansion of telehealth services across the nation.
CTeL is actively analyzing the proposed rule and is committed to ensuring the voice of the telehealth community is heard.
What is the Physician Fee Schedule?
The Physician Fee Schedule (PFS) is the comprehensive list of fees that Medicare uses to pay doctors and other clinicians for their services. Each year, CMS proposes and finalizes updates to the payment rates, policies, and covered services. These updates can influence everything from the financial viability of a practice to the adoption of innovative care delivery models like telehealth.
Key Highlights in the CY 2026 Proposed Rule for Telehealth
While a full analysis is ongoing, the CY 2026 proposed rule introduces several important topics for discussion that could shape the future of virtual care. Key areas of focus include:
Telehealth Services List: Proposed additions or removals of services eligible for reimbursement when delivered via telehealth.
Reimbursement Rates: Adjustments to payment rates for telehealth services, including policies related to geographic adjustments and payment parity.
Supervision Requirements: Potential modifications to the requirements for direct supervision, which could allow for greater use of virtual technologies to supervise junior clinicians.
Behavioral Health: Continued focus on expanding access to virtual mental and behavioral healthcare, a critical priority for patients and providers.
Remote Therapeutic Monitoring (RTM): Proposed refinements to the coding and payment policies for Remote Therapeutic Monitoring services.
Understanding the nuances of these proposed changes is essential for any organization involved in providing or supporting telehealth services. The policies finalized in this rule will set the stage for telehealth operations in 2026 and beyond.
Your Voice is Crucial: The Public Comment Period
The release of the proposed rule opens a vital window for public comment. This is a direct opportunity for stakeholders—including providers, health systems, technology innovators, and patients—to provide feedback to CMS. Your real-world experiences and expert insights can influence policy and help create a final rule that supports robust, equitable, and sustainable telehealth.
CTeL values the expertise of its members and will be submitting a formal comment letter to CMS, consolidating the perspectives of the broader telehealth community.
Call to Action: Submit Your Comments to CTeL!
To ensure our response to CMS is comprehensive and reflects the diverse experiences of our members, we are collecting your feedback, concerns, and recommendations. Share with us how the proposed changes will impact your practice, your patients, and your operations.
Please submit your comments and analysis to CTeL by:
Tuesday, August 12, 2024
This deadline will allow our policy team sufficient time to review all submissions and incorporate them into our formal letter to CMS.
How to Submit:
Email your comments to: LydiaH@ctel.org
Subject Line: CY 2026 PFS Proposed Rule Comments
Please include: Your name, organization, and specific sections of the rule your comments address.
Telehealth Policy 411: What You Need to Know
To secure legislation making telehealth access permanent, congress needs the right research and information for an accurate Congressional Budget Office (CBO) score. To accurately score the Telehealth Modernization Act (TMA) for its permanent implementation, Congress and the CBO should undertake the following steps:
Comprehensive Data Collection: Gather extensive data on telehealth utilization, costs, and outcomes. This includes analyzing spending patterns, service usage, and patient outcomes within Medicare, as well as reviewing studies on telehealth's impact on healthcare delivery and costs.
Evaluate Substitution vs. Supplementation Effects: Assess whether telehealth services replace in-person visits (substitution) or add to overall healthcare utilization (supplementation). Understanding this distinction is crucial, as increased utilization can lead to higher costs.
Analyze Payment Parity Implications: Examine the effects of reimbursing telehealth services at rates equivalent to in-person visits. Consideration should be given to whether this parity leads to increased utilization and spending, or if adjusted rates could better align with the cost structure of telehealth services.
Monitor for Fraud and Abuse: Implement measures to detect and prevent fraudulent activities within telehealth services. This includes establishing monitoring systems to identify outlier billing patterns and ensure compliance with healthcare regulations.
Consider Long-Term Projections: Incorporate long-term cost projections, potentially extending beyond the standard 10-year budget window, to fully capture the financial implications of making telehealth provisions permanent. This approach can provide a more accurate assessment of future costs and savings.
Legislative Coordination: Ensure that legislative proposals include detailed provisions addressing the above factors. Clear legislative language can facilitate a more precise CBO scoring process by outlining the scope, limitations, and intended outcomes of the telehealth services to be covered.
By following these steps, Congress can work with the CBO to develop an accurate and comprehensive budgetary score for the Telehealth Modernization Act, facilitating informed decision-making regarding its permanent implementation.
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