By: Center for Connected Health Policy

Policymakers have typically been cautious about enacting extensive regulations around artificial intelligence (AI), but as AI becomes more common, meaningful policy changes have gradually been accelerating. CCHP is currently monitoring 94 pending policies at both the state and federal levels regarding AI and healthcare through its Telehealth Legislation and Regulation tracker. Most significant AI policy adoption has occurred at the state level thus far, and recent AI developments at the federal level continue to focus around a largely deregulatory approach to its use.   Recent Federal AI Policy Developments As one of his first actions this term, on January 23, 2025, the President signed Executive Order (EO) 14179, Removing Barriers to American Leadership in Artificial Intelligence. The order seeks to revoke any existing policies that may limit American AI innovation, while also positioning the U.S. at the forefront of global AI leadership. In particular, the EO calls for the development of an Artificial Intelligence Action Plan across various federal agencies within 180 days of the order (by July 22, 2025), including identifying inconsistent policies that may be subject to revocation, as well as requiring the Office of Management and Budget (OMB) to revise particular prior administration procurement policies (OMB Memoranda M-24-10 and M-24-18) within 60 days of the order. In response, on April 7, 2025 the OMB released two new policy memos (M-25-21 and M-25-22) regarding federal agency use of AI and federal procurement. According to the fact sheet regarding the memos, they are meant to signal a fundamental shift toward pro-innovation and pro-competition policy, and away from more risk-averse approaches. The fact sheet also notes particular examples of how federal agencies are currently maximizing the benefits of AI, including the Department of Veterans Affairs (VA), which uses AI tools to optimize patient care, such as supporting the identification and analysis of pulmonary nodules during lung cancer screening exams to improve detection and life-saving diagnoses.   The key points included in the two new memos are summarized as follows: OMB Memorandum M-25-21, Accelerating Federal Use of AI through Innovation, Governance, and Public Trust – Rescinds and replaces OMB Memorandum M-24-10, Advancing Governance, Innovation, and Risk Management for Agency Use of Artificial Intelligence. – Directs agencies to: – Accelerate the Federal use of AI by focusing on three key priorities: innovation, governance, and public trust. – Remove unnecessary and bureaucratic requirements that inhibit innovation and responsible adoption, develop strategies that elevate AI adoption and innovation as a priority, while increasing transparency to the American public, civil society, and industry. – Invest in the American AI marketplace and maximize the use of US developed/produced AI products and servicesIdentify Chief AI Officers for each agency and OMB will convene an interagency council to maximize efficiencies and coordination – Implement minimum risk management practices for AI that could have significant impacts when deployed (high-impact AI) and prioritize safe, secure, and resilient AI. OMB Memorandum M-25-22, Driving Efficient Acquisition of Artificial Intelligence in Government – Rescinds and replaces OMB Memorandum M-24-18, Advancing the Responsible Acquisition of Artificial Intelligence in Government. – Seeks to ensure a competitive American Al marketplace – Acquiring solutions at the lowest cost, accelerating adoption of AI while avoiding costly dependencies on a single vendor, as well as communicating clear vendor requirements. – Aims to safeguard taxpayer dollars by tracking AI performance and managing risk – ensuring AI systems are consistent with their stated purpose and deliver consistent results to preserve public trust. – Promotes effective AI acquisition with cross-functional engagement, robust collaboration across agencies. OMB Memorandum M-25-22 also notes that its guidance should be considered in concert with other more general federal policies that may also apply to AI. Additionally, it states that for guidance on regulatory and non-regulatory approaches to AI applications outside of the federal government, agencies should consult OMB Memorandum M-21-06, Guidance for Regulation of Artificial Intelligence Applications, which was released November 17, 2020. The 2020 guidance is largely consistent with the above themes regarding encouraging innovation and growth in AI and reducing unnecessary barriers to the development and deployment of AI. It also notes consideration of non-regulatory approaches, including promoting sector-specific frameworks and voluntary standards. For instance, as mentioned in a recent TechTargetarticle regarding AI, the healthcare industry is already creating frameworks to ensure responsible uses of AI through collaboratives such as the Coalition for Health AI (CHAI)and the Trustworthy & Responsible AI Network (TRAIN). In terms of regulatory approaches, the memo also mentions that “agencies may use their authority to address inconsistent, burdensome, and duplicative state laws that prevent the emergence of a national market.”   Recent State AI Policy Developments As we see states adopting more AI policies, how those laws may interact with federal AI regulations will remain an important area to watch. We have seen a patchwork of inconsistent policy adoption across states and the federal government specific to telehealth over the years, which makes compliance and utilization of remote care increasingly more complicated. Nevertheless, states often have different interests and authorities that drive them to promote specific policy goals – such as improving access to care, protecting patient data, controlling costs, or mitigating risks related to new innovations – that may not always align with federal priorities. Some of the most common areas we have seen state AI policy focus around include states adopting their own AI advisory bodies, procurement related processes, as well as research and reporting policies. For instance, last year Indiana adopted SB 150 to create an artificial intelligence task force to study and assess use of AI technology by state agencies, while Maryland adopted SB 818, which requires state departments to conduct data inventories regarding artificial intelligence systems, as well as a subsequent report and recommendations, regarding the use of systems that employ artificial intelligence in health care delivery and human services. Another common policy found at the state level specific to healthcare is ensuring provider AI oversight and patient transparency related to AI uses. For example, California approved AB 3030 last year, which requires healthcare providers and facilities that use generative artificial intelligence to generate written or verbal patient communications to ensure that those communications include both a disclaimer that indicates to the patient that a communication was generated by generative artificial intelligence, as well as clear instructions describing how a patient may contact a human health care provider, employee, or other appropriate person. The bill would exempt from this requirement a communication read and reviewed by a human licensed or certified health care provider. Additionally, California adopted SB 1120, which requires health plans and insurers that use an artificial intelligence, algorithm, or other software tool for the purpose of utilization review or utilization management functions to ensure compliance with specified requirements, including that the artificial intelligence, algorithm, or other software tool bases its determination on specified information and is fairly and equitably applied. Arizona is also considering similar legislation, HB 2175, which would prohibit AI from being used by insurers to deny claims or prior authorizations for medical services and require a healthcare provider to review each claim or prior authorization request before issuing a denial.   Inconsistent Policies and Lessons from Telehealth As mentioned previously, the confusion that inconsistent policies may create can even be evidenced within the aforementioned federal guidance. For instance, Executive Order (EO) 14179 references a different definition for AI (15 U.S.C. 9401(3)) than OMB Memorandum M-25-21 (Public Law 115-232 (238(g))). Meanwhile, OMB Memorandum M-25-22 references a different definition for “artificial intelligence system” (Public Law 117-263 (7223(4)) and OMB Memorandum M-25-21 creates policies specific to “high-impact AI.” AI is considered high-impact when its output serves as a principal basis for decisions or actions that have a legal, material, binding, or significant effect on rights or safety. Therefore, as part of conducting internal reviews of high impact use, the memo states that agencies should evaluate the AI’s specific output and its potential risks when assessing the applicability of the high-impact definition. A high-impact determination is possible whether there is or is not human oversight for the decision or action. While different definitions often serve different purposes, they can also generate confusion around what is captured and required in each specific instance. This is why CCHP closely tracks the different definitions of telehealth on its website, as jurisdictions often create definitions specific to Medicare/Medicaid and private payers, as well as differing definitions for telehealth specific to provider professional requirements. While this may be common practice – different policy definitions within and across jurisdictions – it also may be an opportunity for policymakers to learn from the path telehealth policy has taken to address potential confusion at the forefront of policy creation, prior to adopting additional AI policies. Oregon for example, enacted HB 4153 last year to establish a task force on artificial intelligence that is required to examine and identify terms and definitions related to AI that may be used for legislation, beginning with examining terms and definitions used by federal agencies. Washington adopted SB 5838, which also creates an AI task force to assess current uses and trends, as well as benefits and risks, and make recommendations regarding AI legislation.   Public policy always has to walk a fine line between promoting technological innovation and protecting consumers, especially in healthcare, where both the care provided and policies implemented should remain as patient-centered as possible. Additionally, clear regulatory guidance across jurisdictions will better ensure policy compliance, though variations are often inevitable and reflective of different jurisdictional policy priorities. Therefore, as AI policy continues to progress, the availability of accurate resources and educational information regarding AI policy remains of utmost importance.   For more information regarding the recent federal AI policy developments, please review Executive Order (EO) 14179, OMB Memorandum M-25-21, and OMB Memorandum M-25-22 in their entirety. For more information on pending AI healthcare policy across jurisdictions, please access CCHP’s Telehealth Legislation and Regulation tracker.   Additional AI resources include: – The National Conference of State Legislatures (NCSL) tracks all AI related legislation on its various websites, including this summary of 2024 AI legislation, 2025 AI legislation, as well as an AI Policy Toolkit. – The Medicaid and CHIP Payment and Access Commission (MACPAC) recently held a panel focusing on the role of AI in the Medicaid prior authorization process, including opportunities to streamline processes as well as concerns related to algorithmic bias, inappropriate denials and oversight. – A recent TechTarget article covered how AI can benefit healthcare and common AI applications. – The California Telehealth Resource Center (CTRC) offers a number of healthcare AI resources in its AI toolkit. – The National Telehealth Technology Assessment Resource Center (TTAC) tracks related technologies, including AI enhanced telehealth devices. – The National Consortium of Telehealth Resource Centers (NCTRC) released an Artificial Intelligence in Rural Health Fact Sheet that can assist rural providers considering adopting AI tools and applications to enhance patient care. – The Coalition for Health AI (CHAI) offers collaborative guidance, including the Blueprint for Trustworthy AI Implementation. – The Trustworthy & Responsible AI Network (TRAIN), a consortium of healthcare leaders seeking to operationalize responsible AI principles. – The Health AI Partnership (HAIP), a multi-stakeholder collaborative seeking to empower healthcare organizations to use AI safely, effectively, and ethically. – The Healthcare Information and Management Systems Society (HIMSS) offers additional digital health resources, such as its AI and Emerging Technologies Toolkit for Healthcare Organizations. – The American Telemedicine Association (ATA) offers specific AI Principles and related resources.

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