- Medicare telehealth policies advance in 2026 final rule
- CMS makes AMA-recommended improvements to the Merit-based Incentive Payment System program
- AMA joins stakeholders to call on congressional leadership to recover access to telehealth for Medicare beneficiaries
- Federation letter supports legislation to repeal ACA moratorium on formation or expansion of physician-owned hospitals
- More articles in this issue
Medicare telehealth policies advance in 2026 final rule
In 2020, under the first Trump administration, the AMA successfully advocated with CMS for significant improvements in Medicare telehealth policies. While some were later made permanent, including coverage of audio-only modalities and addition of many services to the Medicare Telehealth List, others have been subject to multiple temporary extensions.
Following six years of advocacy, the 2026 MPFS final rule is a significant step forward, permanently allowing virtual direct supervision and permanently lifting frequency limits on providing subsequent hospital inpatient and nursing facility visits and critical care consultations furnished via telehealth. CMS will now permanently allow physicians to be immediately available via audio-video telecommunications for all services that require direct supervision except those with a 10- or 90-day global period.
In addition, CMS reversed its proposal to limit virtual teaching physician supervision of residents providing telehealth services in non-metropolitan areas and no longer allows virtual supervision of residents in metropolitan areas. The final policy permanently allows virtual supervision of residents providing telehealth services in all training settings.
CMS also discusses concerns raised by the AMA and others regarding expiration of flexibility at the end of 2025 that has allowed physicians providing telehealth services from their homes to use their currently enrolled practice location instead of listing their home address in the Medicare enrollment database. The agency clarifies that, although it is not further extending this flexibility, subregulatory guidance states that physicians who mark the address as “Home office for administrative/telehealth use only” will suppress their street address details in the Medicare database.
CMS makes AMA-recommended improvements to the Merit-based Incentive Payment System program
Following ongoing advocacy by the AMA, CMS finalized several improvements to the 2026 Merit-Based Incentive Payment System (MIPS) program, keeping its focus on stability in the program. As a result, CMS maintains the performance threshold to avoid a MIPS penalty of up to 9% at 75 points for the CY 2026 performance year/2028 MIPS payment year through the CY 2028 performance year/2030 MIPS payment year. CMS notes that 87.37% of MIPS-eligible clinicians will receive a positive payment adjustment for the 2026 MIPS payment year based on their performance in the CY 2024 performance period. The stability with the performance threshold should continue to provide physicians with an opportunity to earn a positive or neutral incentive.
CMS also finalized the following improved policies for the 2026 performance period for MIPS performance categories, which include:
- The addition of the AMA-stewarded Screening for Abnormal Glucose Metabolism in Patients at Risk of Developing Diabetes measure. The AMA appreciates that CMS also made changes to the methodology for calculating administrative claims quality measures to align with the cost measures and how it classifies topped-out quality measures.
- The establishment of a two-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback and find opportunities to improve performance before a new cost measure affects their MIPS final score.
- Improvements to the Total Per Capita Cost measure attribution method.
- The establishment of a measure suppression policy for the Promoting Interoperability performance category, including suppression of the Electronic Case Reporting measure for the current CY 2025 performance period/2027 MIPS payment year.
CMS also modified all 21 existing MIPS Value Pathways (MVPs) to align with the AMA’s recommendations on an alternative framework for structuring MVPs by finalizing “Clinical Groupings” within MVPs. CMS finalized an AMA-supported proposal to allow multispecialty small practices to report an MVP as a group and be required to form subgroups.
AMA joins stakeholders to call on congressional leadership to recover access to telehealth for Medicare beneficiaries
The AMA has joined a sign-on letter (PDF) from a broad range of stakeholders urging congressional leaders to immediately act on a long-term telehealth fix in its next legislative package to ensure stability and provide clarity for patients, providers and the health care system as a whole.
Congress extended Medicare telehealth flexibilities multiple times immediately prior to the looming deadlines. The current waiver ended on Sept. 30, resulting in an abrupt end to telehealth services for millions of Medicare beneficiaries. The issue is now tied up with the government shutdown fight.
This cycle of temporary fixes has resulted in patients and providers facing continued disruptions in care. Another short-term extension is unacceptable. Congress needs to act to permanently authorize Medicare telehealth services.
Federation letter supports legislation to repeal ACA moratorium on formation or expansion of physician-owned hospitals
On Nov. 3, the AMA submitted a Federation sign-on letter (PDF) to Reps. Beth Van Duyne (R-TX) and Henry Cuellar (D-TX) expressing the strong support from broad state medical associations and national medical specialty societies for H.R. 4002, the “Patient Access to Higher Quality Health Care Act of 2025.” This bipartisan legislation would repeal the statutory restrictions on the whole hospital exception to the Stark physician self-referral law, thereby eliminating statutory and regulatory barriers that prevent the formation or expansion of physician-owned hospitals (POHs) that were enacted as part of the Affordable Care Act (ACA). The letter notes that Congress has a clear opportunity to improve care and promote competition without creating new spending programs or administrative burdens by enacting H.R. 4002 and allowing physicians to invest in hospitals and value-based care in their communities.
