Critical-access hospitals warn that they will no longer be able to bill Medicare for telehealth services when the public health emergency ends after they were excluded from the government spending bill that the US House of Representatives passed Wednesday.

The $1.5 trillion package would extend Medicare coverage of telehealth for five months after the end of the public health emergency for several types of providers, but not for critical-access hospitals, which primarily serve rural areas.

It is not yet clear why CAHs weren’t included, but advocates say they are going to fight to ensure the issue is fixed before the PHE ends, which could be as soon as July.

Federally qualified health centers, rural health clinics, physical and occupational therapists, hospice care and other Medicare providers were included in the telehealth extension.

“Leaving CAHs out of the legislation, in our opinion, is just going to hurt rural care disproportionately,” said Josh Jorgensen, government affairs and policy director for the National Rural Health Association. “There’s been a large recognition amongst policymakers that telehealth is a good thing, and they want to see it advance, which is why it was included in this package. But, unfortunately, we’re leaving out a provider type and it’s going to cause an interruption of services.”

The Centers for Medicare and Medicaid Services designate certain rural hospitals as critical access. These providers receive cost-based reimbursement to help them stay financially viable, and are typically located more than 35 miles from another hospital.

CAHs have been using telehealth to connect with patients since 2020 when CMS began temporarily allowing it. It has especially been helpful in delivering behavioral health to their communities, Jorgensen said.

When Congress passed a COVID-19 response bill in early 2020, it gave the HHS secretary the authority to waive Medicare telehealth restrictions during the public health emergency. That legislation also did not include critical-access hospitals, but CMS was able to temporarily pay them for telehealth services under emergency powers through the Hospitals Without Walls Program, which expires at the end of the PHE.

If the PHE ends in July, as is widely expected, “that means critical access hospitals’ ability to furnish telehealth will come to an end,” Jorgensen said.

The issue has caught attention on Capitol Hill.

Several bills, including one introduced by Sens. Joe Manchin (DW.V.), Joni Ernst (R-Iowa), Jeanne Shaheen (DN.H.) and Jerry Moran (R-Kan.), would permanently allow Medicare coverage of telehealth services at CAHs.

“The telehealth provisions included in the omnibus are a step in the right direction, and I’m pleased multiple provisions I’ve championed are included,” Manchin said in a statement to Modern Healthcare. “As we move forward, I will continue advocating for rural telehealth needs, including those of critical access hospitals, to ensure all West Virginians have access to the quality, affordable healthcare they deserve.”

Spokespeople for the House Ways and Means Committee and Senate Finance Committee, which have jurisdiction over the bill, did not respond to a request for comment.

Congress extended the telehealth flexibilities for another five months to give providers more time to collect data on costs and utilization. Many lawmakers hoped for permanent permanent telehealth policy extensions, including one that allows Medicare beneficiaries to access the services from their homes. Congress may address CAHs’ telehealth pay issues in future legislation.