CMS Proposed Telehealth Expansion: August 2020 Policy Snapshot

Historical context (reviewed November 2026): This article describes CMS’s proposed Medicare Physician Fee Schedule changes in 2020, not a rule currently awaiting public comment. CMS subsequently issued its 2021 Physician Fee Schedule final policy on December 1, 2020, with selected changes to Medicare telehealth services. Later federal legislation extended many Medicare telehealth flexibilities through December 31, 2027, subject to applicable requirements; see current HHS policy guidance. The October 2020 comment deadline and other proposed dates below are historical.

In response to the COVID-19 pandemic since mid-March, the Centers for Medicare and Medicaid Services (CMS) worked quickly to issue emergency guidance that allowed temporary expansion of payment for telehealth services and provided certain flexibility in providing telehealth services. The COVID pandemic has significantly increased awareness of the benefits of telehealth, as many patients have been able to obtain medical services via telecommunications technology from the comfort of their homes and away from unnecessary exposure to the coronavirus.

Under the Medicare program, over 10 million beneficiaries received telehealth services between mid-March and early July, which is a vast increase from the approximate 14,000 beneficiaries per week who were using telehealth services prior to the pandemic. In an effort to maintain this momentum and ensure that the benefits of telehealth are permanently realized, CMS has issued a proposed rule that will expand telehealth services to Medicare beneficiaries even after the COVID pandemic ends. The proposed rule was issued in response to an Executive Order signed by President Trump that aims to improve access to convenient and high-quality care, particularly in rural areas.

Under the proposed rule, several types of services would be permanently approved for delivery via telehealth, including traditional home visits for evaluating and managing patient treatment and certain provider visits for patients with cognitive impairments. Other services that have been approved for telehealth benefits during the COVID pandemic, such as emergency room visits, would also be expanded on a temporary basis through the end of the calendar year in which the pandemic will end. CMS believes that this expansion will provide enough time for CMS and key stakeholders to consider whether such services should be permanently approved for delivery via telehealth.

Similarly, during the pandemic, CMS revised its definition of “direct supervision” to allow physicians to supervise mid-level providers through a virtual (rather than physical) presence using two-way audio and video real-time communication technology. The proposed rule would expand this revised definition of direct supervision through December 31, 2021.

The proposed rule was open for public comment until October 5, 2020. Further information on the proposed rule is available on the CMS website.