WASHINGTON — Skilled nursing facility operators and national advocacy groups are renewing calls for permanent Medicare telehealth legislation, warning that temporary waivers leave rural residents and their providers in a recurring cycle of uncertainty — one that was thrown into sharp relief during the 43-day federal government shutdown last fall.
The push follows a period of disruption in which Medicare telehealth waivers lapsed on October 1, 2025, during the shutdown, cutting off coverage for more than four million Medicare beneficiaries before Congress acted. The Consolidated Appropriations Act of 2026, signed into law on February 3, 2026, extended the broadened telehealth flexibilities through December 31, 2027 — but advocates say another multi-year patch is not a substitute for a permanent fix.
“The government shutdown for 43 days put a big spotlight on what happens to patient access to services without the telehealth authority,” said Cynthia Morton, CEO of ADVION, a national advocacy organization representing therapy and ancillary service providers in post-acute care.
Rural Facilities Face the Sharpest Access Gaps
For nursing home operators in rural states, the stakes are especially high. Care Initiatives, an Iowa-based operator of more than 40 long-term care facilities — the majority in rural communities — relies on telehealth to bridge persistent provider shortages in psychiatry, behavioral health, and specialty therapy.
“There’s not enough of those providers to go around, so our residents do rely on telehealth to have those sessions at times, in those moments of need,” said Jessica McDyer, senior vice president and chief operating officer of Care Initiatives. “If we don’t have the providers that want to be in rural America, we’re going to need to be able to embrace telehealth more frequently.”
Federal data underscore the scale of the workforce gap. More than one-third of the U.S. population lacks adequate access to mental health professionals, according to current federal shortage area designations. Rural residents face wait times up to three times longer than their urban counterparts, with some regions offering no local psychiatric care within a 100-mile radius, according to the Rural Health Information Hub.
CMS Takes Steps Toward Permanence, but Gaps Remain
The Centers for Medicare & Medicaid Services (CMS) took steps toward long-term stability in its Calendar Year 2026 Physician Fee Schedule final rule, permanently eliminating frequency limits on subsequent nursing facility visits and critical care consultations delivered via telehealth. That regulatory change, finalized ahead of the legislative extension, was welcomed by long-term care advocates as a meaningful step.
But the core flexibilities that most affect rural nursing home residents — including the ability to receive nonbehavioral telehealth services at home or in a facility without geographic restrictions — remain tied to the 2027 extension. Without further congressional action before December 31, 2027, Medicare would revert to pre-pandemic rules that generally restrict covered telehealth to patients in qualifying rural facilities, with the home no longer counting as an originating site for most services.
Behavioral health telehealth fared better in the final rule. CMS permanently allowed Medicare patients to receive behavioral and mental health telehealth services at home regardless of geography, and permanently authorized Federally Qualified Health Centers and Rural Health Clinics to serve as distant-site providers for those services.
Industry Presses for Expanded Telehealth Access Act
Advocacy groups, including ADVION, are backing the Expanded Telehealth Access Act, proposed legislation that would make permanent a broader set of the pandemic-era telehealth flexibilities rather than extending them through successive funding bills.
Morton pointed to the 2025 shutdown as a cautionary example. When the waivers lapsed on October 1 of that year, providers had to navigate coverage gaps in real time — even as they continued delivering care to high-need residents. The retroactive coverage provision included in the February 2026 legislation restored reimbursement for services delivered during the four-day lapse between January 31 and February 3, but operators said the episode illustrated the operational and clinical risks of relying on stop-gap extensions.
Telehealth infrastructure itself remains uneven. Approximately 19 million Americans lack fixed-broadband service at minimum threshold speeds, according to Federal Communications Commission data, and 75% of those households are in rural areas — the same communities where nursing home telehealth need is greatest.
Providers say that until Congress codifies permanent authority and broadband gaps are addressed, rural nursing home residents will remain vulnerable to the kind of coverage disruption seen in late 2025.
Why This Matters for Home Care
The same rural provider shortages and telehealth access barriers that affect nursing home residents apply equally to older adults and people with disabilities receiving care at home — who often have no facility-based safety net to fall back on when specialist access disappears.
For families managing home care without reliable access to visiting specialists, the quality and adaptability of home care equipment becomes a critical variable. The SonderCare Aura home hospital beds — certified to International Hospital Standard and equipped with a full clinical positioning suite including Trendelenburg, Zero Gravity, and FallSafe Ultra-Low Height — are designed to support the kind of complex care needs that rural families are often navigating without consistent in-person clinical backup.
If your family is managing home care in an area with limited specialist access, the right equipment can reduce the frequency of urgent interventions and support safer day-to-day caregiving. Explore SonderCare’s home hospital beds or speak with a care specialist to find the right configuration for your situation.
Sources: Skilled Nursing News (March 24, 2026); Center for Medicare Advocacy; Telehealth.HHS.gov — CMS Telehealth Policy Updates; Rural Health Information Hub — Mental Health Provider Shortage Areas (January 2026); Federal Communications Commission Broadband Progress Report (2025)
