Legislative Actions and Updates
An overview of the latest policy changes and updates impacting digital health.
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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