Telemental Health Laws: 2026 Overview

Both this Executive Summary and the content in the Telemental Health Laws app are for informational purposes only and are not intended as a comprehensive statement or summary of the relevant laws on this important topic. Always consult with counsel regarding your specific legal and regulatory questions.

This year’s Telemental Health Laws app update highlights a pivotal transition, as narrowed Medicare coverage, delayed U.S. Drug Enforcement Administration (DEA) rulemaking on remote prescribing, and intensified federal enforcement create new operational and legal complexities for telehealth providers nationwide.

Key Takeaways for Telehealth Providers and Organizations:

• Unstable Medicare rules make long-term planning difficult. Flexibilities can change with short notice, putting reimbursement, care models, and staffing decisions at risk for mental and behavioral health providers.
• Remote prescribing remains uncertain and complex. While telehealth prescribing is still allowed, permanent DEA rules are delayed. Providers face ongoing confusion about compliance, platform requirements, and state-by-state differences.
• Compliance risk is rising fast. Federal enforcement is expanding, with closer scrutiny of billing, documentation, and prescribing. One mistake can trigger audits, penalties, or legal exposure.

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Introduction

Since 2016, Epstein Becker Green attorneys have researched, compiled, and analyzed state-specific content relating to the regulatory requirements for professional mental/behavioral health practitioners and stakeholders seeking to provide telehealth-focused services. We are pleased to once again release our latest update to Epstein Becker Green’s Telemental Health Laws app, an extensive compilation of laws, policies, and other state guidance for practitioners and providers in telehealth.

From Emergency to Uncertainty: Medicare Telehealth After the PHE

As of January 5, 2026, Medicare telehealth flexibilities initially put in place during the COVID-19 public health emergency (PHE) remain available through at least January 30, 2026. These flexibilities have been in place since March 2020 and were extended numerous times. Most recently, the Continuing Appropriations, Agriculture, Legislative Branch, Military Construction and Veterans Affairs, and Extensions Act of 2026 (the “2026 Continuing Appropriations”), passed on November 12, 2025, extended the flexibilities through January 2026. Prior to that, the American Relief Act of 2025, passed in December 2024, extended the flexibilities through March 2025, and a March 15, 2025, continuing resolution again extended the flexibilities through September 30, 2025. Although the most recent attempts to further extend the flexibilities (while lawmakers continued to consider whether to make any additional flexibilities permanent) did not pass before the September 30 deadline, and were apparently delayed by the federal government shutdown that began on October 1, 2025, the 2026 Continuing Appropriations applies telehealth flexibilities retroactively, as if there were not a temporary lapse in the application of telehealth flexibilities during the period from October 1, 2025, through November 12, 2025.

As a result, at least through January 30, 2026, Medicare beneficiaries outside of an approved originating site or geographic area remain eligible to receive reimbursable telehealth services in their homes. Moreover, Medicare in-person visit requirements for mental health services furnished through telehealth remain on hold. With limited exceptions, those requirements obligate a patient to have an in-person visit within six months prior to an initial telehealth visit and every 12 months thereafter.

In addition, the grace period allowing federally qualified health centers and rural health clinics to continue conducting mental health visits through real-time audio and video telecommunications technology has also been extended through at least January 30, 2026. Audio-only visits are generally not reimbursable unless a patient cannot or will not use video, provided that the provider is technically capable of using audio-video technology.

On the legislative front, efforts to extend telehealth flexibilities continue, as seen in the introduction of H.R. 4206 (the CONNECT for Health Act of 2025) and H.R. 5081 (the Telehealth Modernization Act), as well as recent unsuccessful attempts to preserve those flexibilities through continuing resolutions—for example, H.R. 5371, H.R. 5450, and S. 2882. Looking ahead, time will tell whether the temporary flexibilities will be further extended, and whether any additional flexibilities will be made permanent in the future through separate telehealth reform legislation enacted by Congress.

DEA Telehealth Rulemaking Delayed Until an Unannounced Date

In 2025, telehealth providers continued to benefit from the DEA’s temporary extension of flexibilities for the remote prescribing of controlled substances, which waived the in-person visit and separate state registration requirements. Because most state laws defer to federal controlled substance prescribing requirements, providers have retained this flexibility beyond the PHE period. Providers, however, must still comply with applicable state prescribing and registration requirements that may be more stringent than federal law.

These broad federal flexibilities were set to expire on December 31, 2025, but were extended for a fourth time, through December 31, 2026, by a temporary final rule issued jointly by the DEA and U.S. Department of Health and Human Services (HHS), titled “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” (the “Fourth Temporary Extension”), which was published in the Federal Register on December 31, 2025. The Fourth Temporary Extension is a direct extension of the prescribing flexibilities that have existed since March 2020.

In terms of permanent prescribing updates, on January 17, 2025, the DEA published two final rules and one Notice of Proposed Rulemaking (NPRM), all concerning remote prescribing. The two final rules apply only in limited contexts. One expands the ability to prescribe buprenorphine via telehealth for the treatment of opioid use disorder, and the other authorizes remote prescribing of controlled substances for Department of Veterans Affairs patients. These rules were originally scheduled to take effect on February 18, 2025, but their implementation was delayed by the Presidential Memorandum issued on January 20, 2025, titled “Regulatory Freeze Pending Review,” which directed agencies to pause and reassess pending regulations. A joint notice from the DEA and HHS, published in the Federal Register on March 24, 2025, further postponed the effective date to December 31, 2025.

The accompanying NPRM, titled “Special Registrations for Telemedicine and Limited State Telemedicine Registrations,” proposes creating three categories of special registrations that would authorize practitioners to prescribe controlled substances via telehealth without an initial in-person evaluation, depending on the type of registration held. Significantly, the proposal would require telehealth companies—specifically, online platforms that connect patients with prescribers and facilitate the prescribing of controlled substances—to obtain their own special registration. The proposed rule would also establish a national prescription drug monitoring program to enhance cross-state visibility into patients’ controlled substance histories for prescribers and pharmacists.

Since the publication of the special registration NPRM in January 2025, and until the issuance of the Fourth Temporary Extension, the DEA had not released further updates, even though the special registration NPRM was not affected by the regulatory freeze. In the preamble to the Fourth Temporary Extension, the DEA explained that it required additional time to evaluate stakeholder feedback received through multiple channels, including the 6,475 comments submitted in response to the NPRM. The agency further stated that extending the existing telehealth flexibilities was necessary to “avoid a lapse of care for patients.” See 90 Fed. Reg. 61305. As prescribers increasingly rely on remote prescribing to maintain patient access to care, the DEA’s ongoing rulemaking remains under close watch as stakeholders await the establishment of a permanent telehealth prescribing framework.

Federal Telehealth Policy Developments

Bipartisan efforts in Congress continue to demonstrate strong support for telehealth. On September 19, 2025, the U.S. Senate passed S. Res. 417, designating September 14-20, 2025, as Telehealth Awareness Week to recognize the impact of telehealth in expanding access to quality care nationwide—particularly for patients in areas with workforce shortages or other barriers to care. Federal recognition continues to build as the Calendar Year 2026 Physician Fee Schedule and more than 20 active bills, including the CONNECT for Health Act and H.R. 2263 (the Telehealth Coverage Act), aim to modernize Medicare’s telehealth policies. These efforts reflect a bipartisan commitment to preserving and strengthening telehealth across the U.S. health care system.

Continued Federal Enforcement Efforts Targeting Telehealth-Related Fraud

As was the case in previous years, the U.S. Department of Justice (DOJ) and the HHS Office of Inspector General (OIG) have continued their aggressive efforts in 2025 to identify and prosecute “telefraud” schemes. In June 2025, DOJ announced the largest National Health Care Fraud Takedown in history, charging 324 defendants (including 96 medical professionals) across the country for schemes involving more than $14.6 billion in intended losses. Of the 324 total defendants, 49 were charged in connection with the submission of over $1.17 billion in allegedly fraudulent claims to Medicare, resulting from telehealth and genetic testing fraud schemes. 

On July 2, 2025, DOJ and HHS launched the False Claims Act Working Group, aiming to enhance coordination, accelerate investigations, and use data analytics to identify potential enforcement targets earlier in the claims cycle. The Working Group is composed of DOJ’s Civil Division, HHS-OIG, the HHS Office of the General Counsel, and the Centers for Medicare & Medicaid Services’ Center for Program Integrity. The Working Group’s stated enforcement priorities include Medicare Advantage billing; drug, device, and biologic pricing; kickbacks; defective medical devices; barriers to patient access; and electronic health record manipulation. The Working Group also plans to increase efficiency in managing qui tam actions and to promote early dismissal of meritless whistleblower suits. While not focused solely on telehealth, the Working Group’s efforts are highly relevant to telehealth providers, particularly in areas such as billing, patient access, and compliance with electronic health record requirements.

These ongoing enforcement actions and program integrity activities at the federal level have put telehealth providers on notice of the need to track and ensure compliance with the applicable legal requirements related to providing telehealth services from both a policy and operations perspective. Telehealth providers should continue to prioritize the development and integration of robust operational compliance infrastructures. We anticipate continued efforts at both the federal and state levels with respect to enforcement and likely coordination between federal and state regulators on these issues.

State Trends and Developments in Telehealth Regulation

Epstein Becker Green’s Telemental Health Laws app is a useful tracking tool for providers to help understand state-by-state changes and developments. Though no two states approach the regulation of telehealth in the same manner, we have discerned a few notable trends among the states in 2025. 

Across many of the health professions, interstate compacts persist as the most meaningful approach by states to address challenges associated with professional cross-state practice. Whereas states generally require physicians and other health care professionals to hold valid licenses to practice that have been issued by the state’s relevant professional boards, interstate compacts have allowed specific types of professionals to engage in cross-state practice as long as they hold a license in good standing in their home state.

States remain active in addressing cross-state practice through new compact participation and legislation. For more information about the ongoing efforts by states to join professional licensure compacts, see the 50-State Professional Licensure Compacts Summary page located within our complimentary Telemental Health Laws app.

Unlike 2024, our 2025 state review did not identify new licensure exception models or temporary telehealth registration frameworks. Most state activity in 2025 focused on expanding or clarifying how telehealth may be used in specific clinical or Medicaid contexts. Here are some examples:

• Nebraska revised its Medicaid administrative code to include audio-only telehealth for behavioral health and crisis management when clinically appropriate and when an existing provider-patient relationship is established.
• South Dakota Medicaid expanded telehealth coverage for certain behavioral health and substance use disorder services and clarified audio-only parameters.
• New York Medicaid clarified its coverage criteria for audio-only telehealth services.
• Pennsylvania authorized initial opioid treatment program admissions via telehealth under defined federal standards.
• Mississippi made its private payer telehealth coverage requirement permanent.

Few large-scale changes were observed this year, signaling that states are maintaining a steady regulatory posture for now as they evaluate the long-term stability of existing telehealth frameworks. 

Conclusions

As the industry transitions beyond the post-PHE era, telehealth providers face a new landscape defined by potentially narrowed Medicare flexibilities, delayed DEA rulemaking, and intensified federal enforcement. Although Congress continues to demonstrate bipartisan support for expanding access to telehealth, telehealth providers will invariably encounter certain legal and regulatory complexities as lawmakers work toward establishing a more permanent regulatory framework. At the same time, states are moving from broad expansion to refinement, focusing on reimbursement precision and licensure compacts.

Telehealth providers should continue to monitor federal and state policy developments—including Medicare coverage rules, DEA prescribing regulations, and False Claims Act enforcement priorities—while simultaneously making investments in compliance infrastructures to operate in accordance with applicable federal and state laws, regulations, and policies.

Download Epstein Becker Green’s Telemental Health Laws App