Author: Julia Ivanova, PhD, MA
Date: September 30, 2025
Key Takeaways
Republican and Democratic continuing resolution proposals included extensions of Medicare telehealth and Hospital-at-Home flexibilities, showing rare bipartisan consensus on virtual care.
The Senate’s rejection of both proposals on September 19 leaves negotiations unsettled just days before the expiration of telehealth flexibilities on September 30.
Without congressional action, Medicare telehealth coverage will revert to pre-COVID restrictions, cutting off reimbursement for home-based visits and threatening critical programs like Hospital-at-Home.
As of Monday morning, September 29, 2025, the legislative schedule still indicates that the House is in recess past the September 30 deadline; the Senate would need to pass the House-led GOP bill in order to avert a government shutdown.
Republican and Democratic leaders met with President Trump on Monday, September 29, 2025, to discuss how to avert a government shutdown, but made little progress.
Continuing Resolution Proposals
With key Medicare telehealth flexibilities set to expire on September 30, 2025, Republicans and Democrats have floated competing Continuing Resolutions (CRs) to extend virtual care rules and Hospital-at-Home flexibilities. Notably, the GOP considered their proposal a clean extension of current spending, which would continue through November 21, 2025. The Democrats’ alternative would have funded the government only through October 31, 2025, and was part of a wider negotiation over Affordable Care Act premium subsidies and Medicaid policy. On September 19, 2025, the Senate rejected both the House-passed GOP proposal and the shorter Democratic alternative, sending negotiators back to the table just days before the flexibilities expire.
What The Failed CRs Proposed For Telehealth
Failed House GOP CR (H.R. 5371)
House Republicans’ proposed CR would have extended a suite of Medicare telehealth flexibilities through November 21, 2025. Their plan included using patients’ homes as originating sites, suspending geographic restrictions, preserving FQHC and RHC distant-site billing, and maintaining expanded practitioner eligibility. It would have allowed audio-only visits and prolonged the Acute Hospital Care at Home waiver through November 21, 2025. It also delayed Medicare’s in-person telemental-health requirement until November 22, 2025.
Failed Senate Democrats’ CR (S.2882)
Senate Democrats offered a parallel measure with nearly identical provisions, but with a shorter end date of October 31, 2025. That package similarly extended Hospital-at-Home and telehealth flexibilities.
Current Status Of Negotiations
Neither side has proposed an updated version, and the Senate’s rejection of both underscores that the details remain subject to ongoing negotiations. Ultimately, including telehealth flexibilities in both earlier proposals demonstrates policymakers’ bipartisan support for progress in virtual care. As of Tuesday, September 30, 2025, the legislative schedule still indicates the House will be in recess until after the deadline, so the Senate would need to pass the House-led GOP bill to avert a shutdown.
Initially, Democrats considered a shutdown as part of their strategy to pressure Republicans into concessions on health care policy; however, with recent threats to use a shutdown as a pretext for mass firings, Democrats are reportedly wavering on this strategy. Trump met with top policymakers–Senate Minority Leader Chuck Schumer (D, NY), Speaker Mike Johnson (R-LA), House Minority Leader Hakeem Jeffries (D, NY), and Senate Majority Leader John Thune (R-SD)–on Monday, September 29, 2025. The meeting ended with little progress to avert a shutdown.
In a joint statement prior to the meeting, Representative Jeffries and Senator Schumer stated, “President Trump has once again agreed to a meeting in the Oval Office. As we have repeatedly said, Democrats will meet anywhere, at any time, and with anyone to negotiate a bipartisan spending agreement that meets the needs of the American people. We are resolute in our determination to avoid a government shutdown and address the Republican healthcare crisis. Time is running out.”
What Happens In A Shutdown?
With just a day left before Medicare telehealth flexibilities expire and the House out of session until October, the prospect of a government shutdown has become more likely. Advocacy groups, including ATA Action, have urged lawmakers to include a retroactive fix in any eventual funding bill to guarantee reimbursement for telehealth services provided during any lapse.
If no extension is enacted by September 30, 2025, providers would immediately lose reimbursement for many Medicare telehealth visits, particularly those delivered to patients in their homes. Pre-pandemic restrictions would snap back, limiting coverage to rural areas and designated facilities. Critical initiatives such as Acute Hospital Care at Home could face significant disruption. Specifically, if Congress fails to enact either a CR (or another piece of legislation) by September 30, 2025, most pandemic-era Medicare telehealth flexibilities will expire on that date, including:
Home as an originating site and geographic waivers.
Expanded Medicare clinician eligibility.
FQHC/RHC as distant-site telehealth providers for Medicare patients.
Audio-only allowances (relevant for non-behavioral telehealth).
Hospital-at-Home waiver authority.
Many Medicare telehealth visits would revert to pre-COVID rules, limiting coverage for urban and home-based care and narrowing the types of clinicians who can bill for services.
Conclusion
Monday’s meeting of key policymakers with Trump presented hope for a bipartisan proposal before a government shutdown. We encourage clinicians to contact their congressional members to urge them to extend virtual care flexibilities. ATA Action has created an advocacy tool to help. Even as telehealth is a bipartisan issue, these flexibilities require the spending bill (or other legislation) to pass Congress and be signed into law by the President by September 30, 2025.
