By: Center for Connected Health Policy

The Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) recently released an additional extension of the effective date for two previously published federal final rules: Expansion of Buprenorphine Treatment via Telemedicine Encounter (Now Effective December 31, 2025)Continuity of Care via Telemedicine for Veterans Affairs Patients (Now Effective December 31, 2025)According to the new rule, the two telemedicine prescribing rules specific to buprenorphine and Veterans Affairs patients noted above, are now to be effective December 31, 2025. This date is consistent with the overall Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications rule, which permits providers to prescribe via telemedicine without meeting statutory in-person visit requirements through December 31, 2025. The announcement comes after another previous delay in these two particular rules taking effect (see more information in CCHP’s February 25th newsletter), as well as amidst the recent extension of the temporary Medicare telehealth waivers to September 30, 2025.   It is important to highlight that these telehealth extensions are specific to federal controlled substances prescribing rules and the federal Medicare program only. In addition, states have their own policies in place that may also impact the use of telehealth, including telehealth policies in state Medicaid programs, state private payer laws, and state professional requirements (all of which can be searched by topic and jurisdiction utilizing CCHP’s Policy Finder tool). While federal telehealth policy is mostly still governed by temporary allowances, state telehealth policies have largely stabilized since the onset of telehealth expansions in 2020, with many temporary changes already absorbed into permanent state policies. As you navigate through the following information it is important to remember that both federal and state policies govern a provider’s utilization of telehealth to provide care.   This week’s newsletter seeks to provide an overview of the recent federal telehealth extensions, a recap of the original prescribing rules released in January 2025, including the proposed special registration rule, while additionally highlighting potentially applicable state policies that providers should also be aware of to ensure full compliance when delivering care via telehealth.   FEDERAL PRESCRIBING RULES   Initial Release:The federal prescribing rules put forth by the DEA were released by the prior administration in January 2025.The original effective date for the final rules was set for February 18, 2025.(See CCHP’s January 21st summary for more details).Initial Delay:In February 2025, the effective date of the final rules was delayed until March 21, 2025.(See CCHP’s February 25th newsletter for more details).Latest Update (as of this newsletter’s writing):The most recent rule issued by the DEA further delays the effective date for:Telemedicine Prescribing of BuprenorphineTelemedicine for Veterans Affairs Patients The new effective date for both is now December 31, 2025.December 31, 2025 is the same date the currently in effect Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications expires.The Special Registration rule proposed in January 2025 with the Buprenorphine and Veterans Affairs final rules remains in proposed status with no current effective date. The public comment period for this rule closed on March 18, 2025. The initial delay of the final rules regarding buprenorphine and Veteran’s Affairs patients noted above sought to solicit public comment regarding the rules in response to the new administration’s White House memorandum, which called for “A Regulatory Freeze Pending Review” allowing agencies time for further review of any fact, law, and policy considerations prior to proposing, issuing, or finalizing any regulatory activities. In the latest rule, the DEA and HHS note receiving 32 comments related to the initial delayed effective date, and in response, “wishes to further postpone the effective dates for the purpose of further reviewing any questions of fact, law, and policy that the rules may raise.” Additionally, the rule notes that new effective dates for these rules do not functionally limit the ability to prescribe via telemedicine in the meantime, because the broader Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications permits telemedicine prescribing, without meeting in-person requirements, through December 31, 2025.   Final Buprenorphine Rule – Effective Date: December 31, 2025   Under the Controlled Substances Act, existing permanent prescribing law (which was active prior to the temporary telehealth waivers going into effect) authorizes telemedicine prescribing only under specified circumstances when no in-person visit has occurred, with few exceptions. The final rule, titled Expansion of Buprenorphine Treatment via Telemedicine Encounter, now creates an additional avenue for practitioners to meet an exception from the Controlled Substances Act when an in-person visit does not need to be conducted. The key provisions of this buprenorphine treatment expansion rule authorizing DEA-registered providers to prescribe buprenorphine for treatment of opioid use disorder (OUD) via audio-only or audio-video telemedicine include:  Prescription Drug Monitoring Program (PDMP) Review: Before issuing a telemedicine prescription for a Schedule III-V controlled substance approved for opioid use disorder (OUD) treatment, the provider must review the PDMP data for the patient’s state.Initial Prescription Limitations: Providers may prescribe an initial six-month supply (split among several prescriptions) without an in-person evaluation. Additional prescriptions require an in-person evaluation or must comply with other forms of telemedicine authorized under the Controlled Substances Act (CSA).Pharmacist Identity Verification: Pharmacists must verify patient identity before filling prescriptions.Notably, the rule does not impact provider-patient relationships where a prior in-person medical evaluation has occurred.   Final Veterans Affairs Rule – Effective Date: December 31, 2025   This final rule, titled Continuity of Care via Telemedicine for Veterans Affairs Patients, authorizes Department of Veterans Affairs (VA) practitioners to prescribe controlled substances via telemedicine to VA patients without a prior in-person evaluation, provided another VA practitioner has conducted an in-person evaluation at any time. Conditions include: Reviewing both the VA electronic health record (EHR) and the state PDMP where the patient is located.If the VA EHR or PDMP is unavailable, prescriptions must be limited to a seven-day supply until the provider can review the required data.This rule does not apply to non-VA-contracted practitioners or those providing care via the community care network (CCN).The DEA has indicated that while this rule is specific to VA practitioners due to their closed-system operation, it may consider extending similar authorities to non-VA providers in the future. Meanwhile, as noted previously, the DEA’s exemption from in-person requirements remains in place through December 31, 2025.   Proposed Special Registration Rule – Effective Date: TBD   The DEA has also proposed a rule, titled Special Registrations for Telemedicine and Limited State Telemedicine Registrations, to establish a permanent framework for telemedicine prescribing of controlled substances, outside of specific buprenorphine and Veterans Affairs circumstances discussed above, and after the expiration of the temporary expansions (discussed more below). The special registration rule was also released in January 2025 with the above two final rules, though because it was released as a proposed rule, rather than a final rule, it is not subject to the latest effective date extensions. This proposed rule creates a special registration framework that authorizes three types of telemedicine registration, in addition to additional prescribing, recordkeeping, and reporting requirements. The special registration framework requires registrants to utilize both audio and video components of an audio-video telecommunication system for each telemedicine encounter. The three types of special registration, include: Telemedicine Prescribing Registration: Allows qualified practitioners to prescribe Schedule III-V controlled substances.Advanced Telemedicine Prescribing Registration: Allows specialized practitioners (e.g., psychiatrists, hospice physicians) to prescribe Schedule II-V controlled substances.Telemedicine Platform Registration: Allows approved online telemedicine platforms to dispense Schedule II-V controlled substances through authorized providers.The proposed special registration rule also requires special registrants to maintain a State Telemedicine Registration issued by the DEA for every state in which a patient is treated by the special registrant, unless otherwise exempted. For additional information on special registration eligibility by provider type and limited exemptions to the state telemedicine registration requirement, as well as proposed registration processes, fees and reporting requirements, please see the proposed rule in its entirety. The public comment period for this rule closed on March 18, 2025. It is unknown how the rule and its review process may unfold as it moves forward within the current administration. Stay tuned to future CCHP newsletters for updates. Current Temporary Extension Rule – Expiration Date: December 31, 2025   While these final and proposed federal regulations discussed above would expand permanent controlled substance prescribing policies, they will not be as broad as what some have become accustomed to during the temporary waiver period, currently set to expire December 31, 2025. Under the latest Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, which has now been extended three times since the flexibilities were initially implemented in 2020 (and is the only federal telehealth prescribing rule currently in effect), providers may prescribe controlled medications via telemedicine without conducting the statutorily required in-person medical evaluation of the patient. Meanwhile, the final and proposed prescribing regulations discussed above create more tailored and limited exceptions to the in-person medical evaluation requirement. Additionally, as noted above and discussed in more detail below, it is important to highlight that current state requirements should also be considered, as they may also apply to the provision of care and prescribing via telehealth.   FEDERAL MEDICARE POLICIES   As previously reported, another temporary federal telehealth policy extension occurred recently, specific to expanded Medicare coverage allowances also initially implemented in 2020. Under permanent federal Medicare policy, telehealth coverage is fairly limited and restricted to patients in rural areas and specific healthcare settings. Under the most recent federal Medicare policy extension, waivers of these limitations and related telehealth expansions are now maintained through September 30, 2025, including: Waiving geographic and specific site requirementsAllowing all eligible practitioners to furnish telehealth services, including federally qualified health centers (FQHCs) and rural health clinics (RHCs)Delaying mental health in-person requirementsAllowances for audio-onlyContinue to allow telehealth to be used to conduct the face-to-face encounter recertification for beneficiaries eligible for hospice care Extending the acute hospital at home programThe temporary Medicare telehealth waivers have been extended multiple times since they were initially enacted five years ago, similar to what has occurred with the federal prescribing allowances. The previous Medicare extension was set to expire yesterday (3/31/25), until Congress passed the latest Continuing Resolution in mid-March, adding at least six more months before the temporary Medicare waivers may potentially expire. As discussed in CCHP’s March 18 newsletter, while this extension can be seen as a step in the right direction, many telehealth stakeholders would prefer a longer and more permanent solution. However, as can be seen in some of the federal prescribing policies being considered, permanent solutions may come with additional stipulations and limitations as well.    STATE TELEHEALTH POLICIES   Individual states hold much of the authority around regulating telehealth. This includes implementing telehealth coverage rules that apply to state Medicaid programs and private payers. States are also responsible for adopting telehealth practice standards for providers licensed by state agencies. These standards may include various consent and prescribing requirements specific to the use of telehealth by a particular provider within the state’s borders. Additionally, telehealth is considered rendered at the patient’s location, so providers must be aware of and comply with multiple state policy frameworks applicable to telehealth if seeking to provide care across state lines. Federal laws applicable to Medicare and telehealth prescribing also stress that federal allowances are conditional upon providers additionally abiding by relevant state laws. Therefore, while federal policies (and the instability surrounding them) are very important to the overall telehealth landscape (especially if treating Medicare patients and prescribing controlled substances), state policies are potentially even more impactful, though often overlooked.   For instance, if a provider seeks to deliver care to Medicaid and commercially insured patients, coverage and reimbursement are primarily governed by state policy. Regardless of Medicare expansions, billing rules for other payers vary and may be more expansive or restrictive. Additionally, in regard to prescribing, providers should be aware that even though federal law establishes a baseline for controlled substance prescribing policies, states may impose stricter requirements, such as mandating in-person visits. For instance, Colorado statute prohibits providers registered as out-of-state telehealth providers from prescribing controlled substances. Similarly, Oklahoma statute states that telemedicine encounters cannot establish a valid physician-patient relationship for purposes of prescribing opiates, benzodiazepines, carisoprodol, or synthetic and semisynthetic opiates — unless it’s for prescribing opioid antagonists, partial agonists, or Schedule III, IV, or V controlled substances approved by the FDA for medication-assisted treatment or detoxification for substance use disorder. These examples illustrate how state laws can either entirely prohibit certain types of prescribing or impose additional criteria, even when federal law permits prescribing controlled substances without prior in-person visits or established physician-patient relationships (as a result of the telehealth waivers discussed previously).   Providers should be mindful of various state-specific nuances. For more prescribing details, refer to the online prescribing section of CCHP’s Policy Finder. Additionally, providers should also consult with the state agency that holds primary authority around licensing and overseeing their particular profession, both in their state as well as the state the patient is located, if applicable, to determine additional state professional requirements regarding the use of telehealth.   As mentioned previously, CCHP tracks both federal and state policies applicable to telehealth, which can be searched using CCHP’s Policy Finder tool by both jurisdiction and topic, including: Federal Telehealth PoliciesMedicare and State Medicaid Telehealth PoliciesLive VideoStore-and-ForwardRemote Patient MonitoringAudio-OnlyConsentOut-of-State ProvidersState Private Payer Telehealth RequirementsCoverage and Reimbursement ParityState Professional RequirementsConsentPrescribing/Establishing Provider-Patient RelationshipCross-State PracticeLicensure Compact MembershipAdditional topics are included in the Policy Finder that aren’t listed above, such as definitions for telehealth, miscellaneous telehealth policies, pending legislation/regulation, and professional board standards that may have been found specific to certain providers and states. As CCHP continues to track federal changes to telehealth policies, it is important to remain mindful of these state telehealth policies as well, and that they are also subject to change. CCHP is committed to keeping readers apprised of the latest telehealth developments at all policy levels, both through our weekly #TelehealthTuesday emails and through ongoing updates to the Policy Finder.   For more information on the recent Medicare telehealth waiver extension, please review the latest Continuing Resolution. For more information on the recent federal prescribing rule delay, review the latest rule in its entirety. Additional information on the individual federal prescribing rules referenced in this write-up and a timeline regarding the evolution of telehealth in federal prescribing policy can be accessed through the following links:Temporary Extension Rule (Currently in effect, expires December 31, 2025): Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled MedicationsBuprenorphine/VA Effective Date Delay to December 31, 2025: Expansion of Buprenorphine Treatment via Telemedicine Encounter and Continuity of Care via Telemedicine for Veterans Affairs PatientsPrevious Buprenorphine/VA Effective Date Delay to March 21, 2025: Initial Buprenorphine & VA Rule Delay Announcement and Comment RequestBuprenorphine Final Rule (New effective date December 31): Expansion of Buprenorphine Treatment via Telemedicine EncounterVA Final Rule (New effective date December 31): Continuity of Care via Telemedicine for Veterans Affairs PatientsSpecial Registration Proposed Rule (No effective date): Special Registrations for Telemedicine and Limited State Telemedicine RegistrationsCCHP Resource: Evolution of Telehealth Controlled Substance Prescribing Timeline (updated March 28, 2025)

Source: Center for Connected Health Policy, personal communication, April 1, 2025