Federally Qualified Health Centers and Rural Health Clinics deliver care to more than 52 million Americans, among them one of every three rural residents. Those safety-net facilities rely on telehealth to reach patients who live multiple hours from the nearest physical site. Although Congress recently prolonged key Medicare rules, FQHCs and RHCs still operate under a reimbursement design that penalizes virtual visits – and that policy cushion is set to vanish after 2027.
The sections below outline what shifted, what stayed the same, and what safety-net executives need to do now to safeguard both revenue and patient access.
What Congress prolonged – and why it matters for safety-net clinics
On February 3, 2026, the Consolidated Appropriations Act (H.R. 7148) became law, extending seven Medicare telehealth flexibilities until December 31, 2027. For FQHCs and RHCs, the pivotal element is continued distant-site status, which lets those entities furnish telehealth services and submit Medicare claims for them.
The statute also retains:
- No geographic boundary for non-behavioral telehealth origins through 2027
- Patient homes as valid originating sites under Medicare
- Audio-only encounters for beneficiaries who lack video or broadband
- Additional disciplines – physical therapists, occupational therapists, speech-language pathologists – on the list of eligible telehealth providers
Behavioral and mental health telehealth received stronger protection: FQHCs and RHCs now hold permanent distant-site authority for those service lines. Because behavioral health accounts for roughly 80 percent of Medicare telehealth volume, that permanent status carries weight.
But the extension remains a time-limited patch. For many safety-net providers, the core issue is not permission to deliver telehealth – it is whether the payment rate covers the cost.
The G2025 reimbursement gap that draws little attention
Medicare requires FQHCs and RHCs to report telehealth visits under a single HCPCS code: G2025. The 2026 national rate is $97.53 per encounter, irrespective of which of the 280-plus eligible telehealth services the clinician provides.
That $97.53 flat rate falls below the all-inclusive rate that RHCs receive for an equivalent in-person encounter. According to the National Association of Rural Health Clinics, this “disincentivizes investment in telehealth technologies.”
Rural health clinics receive a single fixed payment for each in-person Medicare visit. When the same beneficiary is seen by telehealth, the clinic collects less money. The difference acts as a financial penalty that pushes providers toward office visits even when remote care suits the patient.
Medicare’s G2025 code bundles all telehealth services into one opaque line on the claim. Clinic staff must pull those services out again on the cost report, a step that adds hours of manual work for teams that already operate with minimal administrative staff.
Consequences if the 2027 extension lapses
The current statute extends multiple telehealth waivers only through December 31, 2027. Unless Congress renews them, the following rules snap back on January 1, 2028:
- Loss of distant-site billing rights for non-behavioral telehealth – Medicare will not pay for medical telehealth visits at FQHCs and RHCs
- Return of geographic restrictions – patients must again reside in a rural or underserved area to qualify for any telehealth service
- End of home-based originating sites for non-behavioral care – patients must travel to an approved facility
- Loss of audio-only coverage for non-behavioral visits, eliminating an option for households without broadband
Congress has already demonstrated a pattern of short-term fixes. In October 2025, a three-week gap in authority forced clinics either to reschedule patients, absorb unreimbursed costs, or gamble on retroactive payment.
Three steps safety-net providers should take now
Instead of waiting for another last-minute vote, FQHCs and RHCs should prepare today.
1. Build a hybrid workflow that survives any policy shift
Design care paths that assign each patient to the modality that best serves the clinical need:
- Route follow-ups and chronic disease checks to video or phone visits
- Reserve exam rooms for new patients and procedures that require physical presence
- Add asynchronous tools – secure messages, intake forms – to lower total visit volume while keeping patients engaged
A white label telehealth platform supplies scheduling, video, and messaging under the clinic’s own brand without custom software development.
2. Link rural patients to specialists through virtual partnerships
The main shortage in rural healthcare is specialist time. FQHCs and RHCs can use telehealth to build referral chains that bring distant specialists onto local screens.
This setup runs smoothly when the FQHC or RHC acts as the coordination point, keeping the patient record while the remote specialist advises by video. A platform worth adopting must carry multi-provider workflows, use HIPAA-grade video, push data into the local EHR, and carry the clinic’s own logo on the patient app. Software already used for millions of visits across hundreds of sites lowers the chance of a rollout failure.
3. Log results and push for permanent rules
The strongest argument for permanent telehealth coverage is data. Every FQHC and RHC needs a simple ledger that records patient outcomes, missed visit counts, cost per encounter, patient ratings, and access numbers for telehealth visits beside in-office visits.
Bills now in the 119th Congress target the pay gap. The CONNECT for Health Act, the Save America’s Rural Hospitals Act, and the Telehealth Modernization Act each add provisions that lock in payment parity and delete the sunset clauses. Clean tables of utilization and outcome data back those measures when staff meet Hill offices.
The tech stack safety-net clinics need
Generic video apps skip several needs that FQHCs and RHCs face every day:
- HIPAA controls coded in, not glued on later
- Audio-only path for homes that lack broadband
- One-time data entry that feeds both EHR and billing screens
- App skin that carries the clinic brand – patients see a trusted name
- Price tiers built for groups of 2 to 50 clinicians
- Install in weeks, not months – the clinic stays level as rules shift
Congress set aside $45.5 million for HRSA’s Office for the Advancement of Telehealth in H.R. 7148. That allocation shows federal investment will keep flowing – clinics should explore how those dollars offset their own upgrade costs.
Keep moving while Congress talks
Short-term extensions will repeat. FQHCs and RHCs that design around the permanent mental health benefit, invest in hybrid visit paths, and pick modular technology will stay upright whatever lands on the docket in 2027.
Fifty-two million patients rely on those organizations – for many, no alternative care site exists. Their access to services should not hinge on congressional calendar dates. A durable virtual care program built today serves both business logic and the communities that count on safety-net providers.
If your organization is comparing telehealth platforms, review what a white label model looks like for safety-net use.
Sources:
- House Passes HR 7148: Medicare Telehealth Waivers Extended to 2027 – WCHSB Insights, 2026
- Telehealth Policy – National Association of Rural Health Clinics – NARHC, 2026
- Medicare Telehealth Utilization by RHCs and FQHCs – The Journal of Rural Health, 2025
- Rural Telehealth Priorities – National Rural Health Association, 2025
- Telehealth Policy Updates – HHS Telehealth, 2026
- The Telehealth Policy Cliff: Preparing for October 1, 2025 – Telehealth Resource Center, 2025