Legislative Actions and Updates
An overview of the latest policy changes and updates impacting digital health.
CTeL Collective Sign-On Letter Urging Congressional Budget Office Officially Score Telehealth
CTeL is continuing our efforts to secure a permanent extension of Medicare telehealth expansion waivers. Central to this effort is for a new evaluation on telehealth's budgetary impact from the Congressional Budget Office, which provides fiscal estimates for Congress. Given a growing body of literature demonstrating telehealth as not only cost-effective but potentially cost-saving, we believe the time is now to urge Congress for permanency. Join us on this letter to Congressional leaders urging for a new telehealth score.
CTeL Advocates for Telehealth Access in DEA’s Buprenorphine Expansion Rulemaking
CTeL has officially submitted its comment letter to the Drug Enforcement Administration (DEA) in response to Docket No. DEA-948 - Expansion of Buprenorphine Treatment via Telemedicine Encounter and Continuity of Care via Telemedicine for Veterans Affairs Patients. This rule represents a pivotal shift in how telemedicine can be leveraged to address opioid use disorder (OUD) treatment, and CTeL is committed to ensuring that telehealth remains an accessible and effective tool for patients and providers.
Telehealth’s Proven Success in OUD Treatment
Since 2020, telehealth has transformed healthcare accessibility, particularly for patients struggling with opioid use disorder. During the pandemic, regulatory waivers allowed providers to prescribe medications for opioid use disorder (MOUD) like buprenorphine via telehealth. These flexibilities resulted in increased access to treatment, improved patient retention, and enhanced quality of care—outcomes that CTeL strongly supports making permanent.
CTeL emphasized in its letter that maintaining telehealth access to MOUD is crucial, especially given the 14.5% decrease in drug overdose deaths between June 2023 and June 2024. CTeL stated:
“After seeing the success of expanded telehealth options since 2020, long-term/permanent implementation of many of these waivers is essential in the interest of promoting greater access to high-quality healthcare.”
Key Policy Concerns: PDMP Requirements
While CTeL supports the expansion of buprenorphine treatment via telemedicine, the organization raised concerns about the Prescription Drug Monitoring Program (PDMP) check requirement in the proposed rule. The challenge lies in PDMP interoperability between states, which could create unnecessary barriers to care. CTeL pointed out that some jurisdictions, such as California, Guam, and the Northern Mariana Islands, do not participate in interstate PDMP data sharing, making it difficult for telehealth providers to comply with the rule.
“We encourage the DEA and HHS to delay or remove this requirement until these issues are resolved.”
CTeL’s Research: Telehealth Does Not Increase Drug Diversion Risk
CTeL also presented findings from its recent study on telehealth and overdose rates, reinforcing that telehealth does not contribute to increased drug diversion risks. The study analyzed telehealth policies in Kansas vs. Missouri and Illinois vs. Indiana, demonstrating a positive impact on reducing overdose rates:
Kansas: A 1.28 per 100,000 reduction in overdose rates after telehealth payment parity was implemented in 2019.
Illinois: A 2.16 per 100,000 reduction following similar policy changes in 2021.
This research supports CTeL’s assertion that telehealth remains a safe and effective modality for OUD treatment, and unnecessary restrictions could harm patient access.
Looking Ahead: Protecting Access to Telehealth
CTeL’s advocacy ensures that telehealth remains a viable solution in combating the opioid epidemic. The organization urges the DEA and HHS to prioritize patient access and finalize the telehealth flexibilities introduced during the COVID-19 pandemic.
As this rulemaking progresses, CTeL remains committed to providing evidence-based insights that shape the legal landscape of digital health.
CTeL Responds: Health Subcommittee Hearing on Modernizing American Health Care: Creating Healthy Options and Better Incentives
Our recent comment letter to the House Ways & Means Subcommittee on Health highlights key policy recommendations and innovations that are driving the future of healthcare delivery.
Telehealth: Expanding Access and Quality of Care
Telehealth has transformed healthcare delivery, particularly during the COVID-19 pandemic. However, uncertainty around long-term policy threatens continued innovation and access. We urge Congress to establish permanent solutions, extending telehealth flexibilities beyond temporary waivers. Our ongoing research will provide critical data to inform future telehealth policies and ensure sustainable integration into Medicare.
Remote Monitoring: Enhancing Patient Outcomes
Remote monitoring technologies, including Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), enable real-time tracking of patient health. These tools have demonstrated immense potential, from post-surgical care to addiction recovery treatment. We advocate for policy changes, such as the passage of the Expanding Remote Monitoring Access Act, to lower barriers to adoption and maximize patient benefits.
Artificial Intelligence (AI): Transforming Healthcare Efficiency and Precision
AI is revolutionizing healthcare by streamlining administrative tasks, improving disease detection, and enhancing patient outcomes. We support policy initiatives that promote safe, transparent, and effective AI use, including robust research, risk management standards, liability protections, and Medicare payment frameworks for AI-augmented services.
Telehealth Policy 411: What You Need to Know
To secure legislation making telehealth access permanent, congress needs the right research and information for an accurate Congressional Budget Office (CBO) score. To accurately score the Telehealth Modernization Act (TMA) for its permanent implementation, Congress and the CBO should undertake the following steps:
Comprehensive Data Collection: Gather extensive data on telehealth utilization, costs, and outcomes. This includes analyzing spending patterns, service usage, and patient outcomes within Medicare, as well as reviewing studies on telehealth's impact on healthcare delivery and costs.
Evaluate Substitution vs. Supplementation Effects: Assess whether telehealth services replace in-person visits (substitution) or add to overall healthcare utilization (supplementation). Understanding this distinction is crucial, as increased utilization can lead to higher costs.
Analyze Payment Parity Implications: Examine the effects of reimbursing telehealth services at rates equivalent to in-person visits. Consideration should be given to whether this parity leads to increased utilization and spending, or if adjusted rates could better align with the cost structure of telehealth services.
Monitor for Fraud and Abuse: Implement measures to detect and prevent fraudulent activities within telehealth services. This includes establishing monitoring systems to identify outlier billing patterns and ensure compliance with healthcare regulations.
Consider Long-Term Projections: Incorporate long-term cost projections, potentially extending beyond the standard 10-year budget window, to fully capture the financial implications of making telehealth provisions permanent. This approach can provide a more accurate assessment of future costs and savings.
Legislative Coordination: Ensure that legislative proposals include detailed provisions addressing the above factors. Clear legislative language can facilitate a more precise CBO scoring process by outlining the scope, limitations, and intended outcomes of the telehealth services to be covered.
By following these steps, Congress can work with the CBO to develop an accurate and comprehensive budgetary score for the Telehealth Modernization Act, facilitating informed decision-making regarding its permanent implementation.
Congress Awards 3 Month Extension for Telehealth Waivers
Passed on December 20, 2025, the American Relief Act, 2025, introduces pivotal measures to expand and sustain telehealth services, demonstrating a strong commitment to ensuring accessible healthcare for Medicare beneficiaries. Key provisions include:
Enhanced Telehealth Flexibilities
Geographic and Originating Site Flexibility: Medicare beneficiaries can now access telehealth services from anywhere, including their homes, eliminating prior geographic limitations and improving care access for rural and underserved populations.
Expanded Provider Eligibility: Physical therapists, occupational therapists, and speech-language pathologists are now authorized to deliver telehealth services, broadening care options.
Audio-Only Services: Patients without video-capable devices can receive certain telehealth services via audio-only communication, promoting inclusivity.
Hospital-at-Home Extensions
Acute Care at Home Waiver: The act extends the waiver allowing hospitals to deliver acute-level care in patients’ homes, an initiative that eases hospital capacity constraints and enhances patient-centered care.
However, the act significantly shortens the extensions for telehealth flexibilities and Hospital Care at Home waivers to just 90 days, creating uncertainty for patients and providers alike. These reduced timelines risk disrupting progress in virtual care, especially for those in underserved areas who depend on these services.
Stakeholders are urging Congress to adopt long-term solutions to preserve these vital healthcare innovations and sustain the momentum gained during the pandemic. Notably, the SUPPORT Act was excluded from this package, leaving additional gaps in comprehensive telehealth policy.
Explore how these changes may impact you and the future of healthcare access.
Federal Guidelines for Opioid Treatment Programs
The Substance Abuse and Mental Health Services Administration published an updated edition of its Federal Guidelines for Opioid Treatment Programs.
The new publication expands on best practices for telehealth, including:
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released an updated edition of the Federal Guidelines for Opioid Treatment Programs (OTPs), introducing new measures to enhance access to treatment and integrate telehealth into care for opioid use disorder (OUD). Key updates include:
Telehealth for MOUD: The guidelines now permit the use of telehealth to prescribe and manage medications for opioid use disorder (MOUD), including buprenorphine and methadone. These measures address gaps in care by allowing OTPs to initiate treatment remotely without requiring an in-person physical evaluation.
Patient Admission Flexibility: Admission processes for OTPs have been revised to accommodate telehealth technologies, including audio-only platforms. These changes aim to increase accessibility for patients in rural or underserved areas and reduce barriers to treatment.
Scope of Practice Expansion: The definition of practitioners eligible to prescribe and dispense MOUD has been broadened to include non-physician professionals, such as nurse practitioners and physician assistants, expanding the workforce available to meet demand.
Increased Take-Home Flexibility: Flexibilities initially implemented during the COVID-19 pandemic, such as take-home methadone doses, have been made permanent, offering patients greater autonomy while ensuring continuity of care.
Stigma Reduction and Patient-Centered Language: The new guidelines incorporate harm reduction principles, including offering fentanyl test strips and HIV/STI testing, and prioritize language that respects patient autonomy.
Improved Compliance Processes: SAMHSA has streamlined accreditation and compliance for OTPs, allowing electronic documentation and corrective action timelines to ensure uninterrupted service delivery
CTeL remains committed to advocating for telehealth as a vital tool in addressing the opioid crisis. By bridging gaps in access, telehealth not only improves admission rates but also increases treatment retention and outcomes. We urge the Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) to continue supporting telehealth innovations as essential to combating the opioid epidemic.
For more details, you can review the complete guidelines on SAMHSA's official site or relevant healthcare policy publications.
Telehealth-Related Changes in the Final OPPS and ASC Rule for Calendar Year 2025
The final rule revising the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for 2025 includes several key updates impacting telehealth services:
Exceptions to the "Four Walls" Requirement for Medicaid Clinic Services:
Expanded Eligibility: The rule finalizes exceptions to the traditional "four walls" requirement, which mandates that Medicaid clinic services be delivered within a physical clinic setting.
Targeted Clinics: These exceptions apply specifically to Indian Health Service (IHS) and Tribal clinics. Additionally, states have the option to extend these exceptions to behavioral health clinics and clinics located in rural areas.
Facilitating Telehealth Delivery: By removing the necessity for services to be confined within clinic walls, these exceptions enable clinics to utilize telehealth technologies. This enhancement allows providers to deliver care remotely, improving access for patients who are geographically isolated or have limited access to in-person services.
Enhanced Access for Underserved Populations:
Rural and Behavioral Health Clinics: The ability for rural and behavioral health clinics to operate outside traditional settings through telehealth supports better healthcare access for populations that may otherwise face significant barriers.
Flexibility in Service Delivery: Clinics can now offer a broader range of services via telehealth, ensuring continuity of care and reducing the need for patients to travel long distances for treatment.
Alignment with Telehealth Expansion Goals:
Consistency Across Care Settings: These changes align Medicaid clinic services with broader telehealth expansion initiatives, promoting uniformity in how telehealth services are delivered and reimbursed across different healthcare environments.
Support for Modern Healthcare Needs: By embracing telehealth, the rule supports the evolving landscape of healthcare delivery, catering to the increasing demand for remote and flexible care options.
Potential Future Enhancements:
Sub-Regulatory Guidance: CMS plans to consider stakeholder feedback and may issue additional guidance on how the four walls requirement applies to Medicaid clinic services delivered via telehealth, ensuring clarity and effective implementation of these exceptions.
Impact Summary: These telehealth-related changes aim to enhance access to healthcare services for underserved and remote populations by allowing Medicaid clinics to deliver care through telehealth platforms. By removing the physical location restrictions, the rule supports more flexible, efficient, and patient-centered care delivery, aligning with ongoing efforts to expand and integrate telehealth into the healthcare system.
For more detailed information, the final rule is scheduled to be published in the Federal Register on November 27, 2024, and will be available online at Federal Register and GovInfo.
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