Partner Thomas (T.J.) Ferrante, a board-certified health care attorney and vice chair of Â鶹´«Ã½â€™s Health Care Practice Group, will present at the 2025 HCCA Honolulu Regional Healthcare Compliance Conference on October 23, 2025. Ferrante’s presentation is titled “Telemedicine Law in Hawaii and Nationwide: A 50-State Assessment of the Pre- and Post-PHE Landscape.â€�

Ferrante’s presentation will explore the ever-changing telehealth policy landscape and provide a practical discussion of hot topics in telehealth law and compliance, and what lawyers and compliance professionals can do to stay abreast in this rapidly changing area. Attendees will have the opportunity to gaze into the metaphorical ‘crystal ball’ to try and get some glimpses of what’s likely to come by examining federal and state policy trends and patterns.

Â鶹´«Ã½â€™s Telemedicine and Digital Health Industry Team, nationally ranked by Chambers, helps organizations and entrepreneurs embrace emerging issues in virtual care, enabling them to provide innovative care for patients in new markets around the block and around the world. Click here for more information on our Telemedicine and Digital Health Industry team.

For more information and to register, .

CLE

The Health Care Compliance Association is a provider/sponsor, approved/accredited by the Alabama State Bar, the State Bar of California, the Pennsylvania Bar Association, the Rhode Island MCLE Commission, and the State Bar of Texas.  CLE credit for qualifying sessions will be available to participants of this conference licensed in these states. Upon request, if there is sufficient time and if there are sessions that meet their CLE requirements, HCCA may submit qualifying sessions to additional state CLE authorities for consideration. This includes meeting state CLE authorities’ requirements for sessions being offered live and virtually Only requests from registered attendees 45 days prior to the event will be considered.

On February 20, 2025, U.S. Senators Dick Durbin (D-IL) and Roger Marshall, M.D. (R-KS) introduced bipartisan legislation, the (the Act), which closes perceived “legal loopholes� in social media advertisements by telehealth companies. The Act would require the U.S. Food & Drug Administration (FDA) to target false and misleading prescription drug promotions by social media influencers and telehealth companies.

Background

Whether or not telehealth companies are under FDA jurisdiction when marketing and promoting prescription drugs has been under debate since The New York Times published its 2019 article, . The report called into question whether telehealth companies are — or ought to be — subject to FDA oversight when advertising drugs and medical devices. Subsequent investigative reporting alleged how some telehealth companies ran ads on social media describing benefits of prescription drugs but failing to describe the risks of these drugs. Reporters claimed telehealth companies promoted drugs for unapproved uses or featured “testimonials� without disclosing whether or not the testimonials came from actual patients or were from paid actors or company employees.

Under the Federal Food, Drug, and Cosmetic Act (FDCA), advertisements for prescription drugs may not be false, lacking in fair balance, or otherwise misleading. Any advertisements for prescription drugs (with the narrow exception of exempt reminder ads), must present a true statement of information in brief summary relating to side effects, contraindications, and effectiveness. The term “side effects, contraindications� means side effects, warnings, precautions, and contraindications, and also includes any such information under such headings as cautions, special considerations, important notes, etc.

Some have claimed these FDCA legal requirements, although clearly applicable to drug manufacturers, packers, and distributors, do not apply to telehealth companies and associated medical providers because the telehealth company and their associated providers are not addressed in the FDCA and not included in the definition of “firm� under applicable FDA Guidance documents. Under this argument, telehealth companies and their associated providers are not subject to these drug advertising laws in their direct-to-consumer marketing campaigns. Former FDA Commissioner Robert Califf how a number of online advertisements by telehealth companies fail to give the complete risk-benefit story (something drug manufacturers must do), as he noted how the FDA lacks the legal authority to regulate the advertising activities of such telehealth companies. 

What’s Next?

If signed into law, the Protecting Patients from Deceptive Drug Ads Act would extend FDA’s jurisdiction to specifically include market surveillance of social media influencers and health care providers for whom a financial benefit exists when such communications contain false or inaccurate statements, omits labeling or other key facts regarding a medication, or fails to include traditional risk and side effect disclosures. The Act authorizes FDA to issue warning letters and civil penalties for non-compliance.

The Act is a bipartisan effort and the controversy surrounding telehealth advertising of prescription drugs is not new. We do not anticipate this issue will fade away soon, although similar legislation previously proposed did not pass. Whether this bill can garner sufficient support remains to be seen. What is clear is there is a growing concern among federal policymakers about what they consider unsafe and imbalanced advertisements for prescription drugs by telehealth companies. Given this climate, a best practice is to ensure advertisements and marketing campaigns are reviewed by skilled advisors who can maintain the effective impact of direct-to-consumer promotions while reducing the legal risk of non-compliant advertising campaigns. As the Act moves through Congress, we will provide updates.

Want to Learn More?

• Regulation of Digital Health Products by FDA
• FDA’s Final Rule on Direct-to-Consumer Advertising – Presentation of Risk Information
• DTC Promotional Labeling and Advertisements: Quantitative Efficacy Wins Over FDA in Final Guidance on Presenting Risk Information
• Scientific Information on Unapproved Uses of Medical Products: FDA’s Final Guidance on Firm Communication to Health Care Providers

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team.

Editor’s Note: This article was on February 7, 2025, and a portion of it is republished here with permission. Read the complete article at Fierce Healthcare.

Virtual medical second opinion (VSO) programs continue to roll out across the country, delivering expert recommendations to better help patients’ diagnoses or treatment options. These VSO programs can offer immense value to patients and their local treating doctors by leveraging the deep expertise of specialists and exporting it to rural communities and geographies that lack such sub-specialty expertise. For all the clinical benefits VSO programs offer, some doctors may be unknowingly exposing themselves to licensure risk under the belief these VSO programs are only “educational� and not the practice of medicine.

More specifically, the argument is that a doctor delivering a VSO is merely providing educational material, but not engaging in the practice of medicine, even though the VSO report itself may contain a diagnosis and treatment recommendations based on the doctor’s review of the patient’s medical records or even direct information provided by the patient. The logical conclusion of the “it’s only educational, not practicing medicine� argument is that the physician delivering the VSO need not be licensed in each state he or she serves. It’s an alluring argument because, if true, it would mean doctors could deliver second opinions to patients across the country without needing to spend the time and expense obtaining medical licenses.

Yet, the argument is largely unsupported by state law. With minor exceptions, the vast majority of doctor-issued VSOs are medical second opinions regarding a specific patient and constitute the practice of medicine. By sidestepping state medical licensing requirements to deliver VSOs, doctors risk facing claims of unlicensed practice of medicine.

Educational vs. Medical Second Opinion

The basic licensure law in each state is, to practice medicine, the doctor must be licensed in the state where the patient is located unless a licensure exemption is met. Each state has a list of exemptions to medical licensure and, while the exemptions are conceptually similar, there are significant technical differences among states.

Most states do offer a licensure exemption for educational services, but the definition of educational does not mean a detailed second opinion. Rather, it generally refers to medical demonstrations performed for the purpose of educating students or other doctors, a CME presentation at a conference, or an article or blog post about a medical condition or treatment generally. In contrast, a VSO tends to be specific to an actual patient, based on that patient’s own medical history and prior records, includes an assessment of the patient’s medical condition and symptoms, offers a potential or actual diagnosis, and concludes with a recommended course of treatment. 

Naturally, it begs the question: does delivering a medical virtual second opinion constitute the practice of medicine? Yes, particularly if the person delivering the VSO:

• Holds themselves out as a doctor with medical expertise;
• Considers the specific patient’s medical history, conditions, records;
• Discusses the patient’s specific medical issues;
• Charges for the VSO service;
• Renders a diagnosis;
• Provides treatment recommendations.

Although doctors delivering VSOs do not always provide actual treatment, they almost always meet the other characteristics above, which means they are very likely engaging in the practice of medicine.

There is a licensure exemption that can be used by doctors delivering VSOs: the peer-to-peer consultation exemption. This exemption allows an out-of-state doctor to consult with a local treating physician about the local physician’s patient and deliver a second opinion (whether it be a quick curbside consult or a formal written second opinion). Nearly every state has a peer-to-peer consultation exemption to medical licensure but the technical specifics vary among states and it is important the requirements are met.

The leading case on interstate unlicensed practice of medicine and the peer-to-peer consultation exemption is Smith v. Laboratory Corporation of America (2010). In it, the federal court held a pathologist located and licensed in the State of Washington had unlawfully practiced medicine without a license when she provided a diagnosis for a patient located in Idaho and failed to meet the requirements of Idaho’s peer-to-peer consultation exemption. The Smith case means that the out-of-state doctor rendering a medical opinion must either: 1) have a license to practice medicine in the state where the patient is located; or 2) carefully structure the arrangement to meet an exemption to licensure and closely follow the specific requirements of the state’s peer-to-peer licensure exemption. Otherwise, the doctor may be found to have practiced medicine without a license.

The real risk of delivering VSOs without following medical licensure rules is borne by the individual doctor rendering the VSO. In most states, the unlicensed practice of medicine is a criminal offense, which means malpractice insurance may likely deny coverage. And if a doctor faces disciplinary action in a state where he or she is not licensed, the doctor may be required to report that to all the states where the doctor is licensed—and every one of those states will likely file reciprocal disciplinary actions like an unfortunate game of dominos. The same holds true for reporting to hospitals and clinics where the doctor holds medical staff membership and privileges.

*                       *                       *

Continue reading the complete article for insights into other potential pitfalls, including the financial and reputational risks of unlicensed care and the evolving regulatory changes to address the ongoing challenges and administrative expenses of multistate licensing.

Want to Learn More?

• Health & Hype Podcast: A Deeper Dive into DEA Telemedicine Controlled Substances
• DEA Unveils Long-Overdue Special Registration for Telemedicine in Proposed Rule
• 50-State Survey of Telehealth Insurance Laws

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team

In the final days of the Biden administration, the Drug Enforcement Administration (DEA) released a that would allow practitioners with a Special Registration to prescribe Schedule III-V, and in limited circumstances Schedule II, controlled substances via telemedicine.

Practitioners with a Special Registration would still need to obtain a DEA registration in each state where they prescribe or dispense controlled substances. However, the proposed rule establishes a limited, less expensive State Telemedicine Registration as an alternative to the traditional DEA registration. The proposed rule imposes several obligations on practitioners with Special Registrations when they prescribe controlled substances via telemedicine. Of note, practitioners would need to be located in the same state as the patient at the time of the encounter when issuing a Schedule II controlled substance prescription, and the average monthly number of Schedule II controlled substances prescribed via telemedicine would need to be limited to less than 50% of the practitioner’s total Schedule II prescriptions (including both telemedicine prescriptions and non-telemedicine prescriptions).

If finalized, the Special Registration process would provide an alternative pathway for practitioners to prescribe controlled substances via telemedicine if the DEA telemedicine prescribing flexibilities currently in place through December 31, 2025, expire. We provide a summary of some of the key provisions of the proposed rule below.

Definitions

The proposed rule introduces several new definitions, some of which include:

• Clinician practitioner — an individual practitioner who provides direct patient care or assesses, diagnoses, or treats medical conditions.
• Platform practitioner — a covered online telemedicine platform that dispenses controlled substances by virtue of its central involvement as an intermediary in the remote prescribing of controlled substances by an individual practitioner. Platform practitioners are subject to the requirements imposed upon non-pharmacist practitioners under the Controlled Substances Act, 21 U.S.C. Sections 801-904, and its regulations.
• Covered online telemedicine platform — an entity that facilitates connections between patients and clinician practitioners, via an audio-video telecommunications system, for the diagnosis and treatment of patients that may result in the prescription of controlled substances, but is not a hospital, clinic, local in-person medical practice, or insurance provider, and meets one or more of the following criteria:
  • The entity explicitly promotes or advertises the prescribing of controlled substances through the platform;
  • The entity has financial interests, whether direct incentives or otherwise, tied to the volume or types of controlled substance prescriptions issued through the platform, including but not limited to, ownership interest in pharmacies used to fill patients’ prescriptions, or rebates from those pharmacies;
  • The entity exerts control or influence on clinical decision-making processes or prescribing related to controlled substances, including, but not limited to: prescribing guidelines or protocols for clinician practitioners employed or contracted by the platform; consideration of clinician practitioner prescribing rates in the entity’s hiring, retention, or compensation decisions; imposing explicit or de facto prescribing quotas; directing patients to preferred pharmacies; and/or
  • The entity has control or custody of the prescriptions or medical records of patients who are prescribed controlled substances through the platform.

Special Registrations

Categories and Eligibility

The proposed rule establishes the following categories of Special Registrations and eligibility requirements:

• Telemedicine Prescribing Registration: This registration would allow clinician practitioners to prescribe Schedule III-V controlled substances.
  • Clinician practitioners would need to demonstrate a legitimate need for the registration.
  • Physicians, nurse practitioners, physicians, and other mid-level practitioners defined under (“mid-level practitionersâ€�) would have a legitimate need to prescribe Schedule III-V controlled substances if they expect to treat patients for whom in-person exams would be burdensome.
    • Examples include patients who experience severe weather conditions, live in remote or distant areas, or have communicable diseases.
• Advanced Telemedicine Prescribing Registration: This registration would allow certain specialized clinician practitioners to prescribe Schedule II-V controlled substances.
  • Specialized clinician practitioners would need to demonstrate a legitimate need for the registration and justify the additional authorization to prescribe Schedule II medications. These practitioners would need to provide information demonstrating their specialized training on their Special Registration application.
  • Specialized physicians and board-certified mid-level practitioners would have a legitimate need to prescribe Schedule II-V controlled substances when treating vulnerable patient populations. This includes individuals who face significant barriers to accessing care and who suffer from debilitating or terminal illnesses.
  • Only specialized physicians and board-certified mid-level practitioners in the following limited circumstances or practice specialties are eligible:
    • Psychiatrists;
    • Hospice care physicians;
    • Palliative care physicians;
    • Practitioners rendering treatment at long-term care facilities;
    • Pediatricians;
    • Neurologists; and
    • Mid-level practitioners and physicians from other specialties who are board certified in the treatment of psychiatric or psychological disorders, hospice care, palliative care, pediatric care, or neurological disorders unrelated to the treatment and management of pain.
• Telemedicine Platform Registration: This registration would allow covered online telemedicine platforms to dispense Schedule II-V controlled substances through a clinician practitioner who holds a Telemedicine Prescribing Registration or Advanced Telemedicine Prescribing Registration (i.e., a platform practitioner).
  • Covered online telemedicine platforms would need to demonstrate a legitimate need for the registration.
  • Covered online telemedicine platforms, in their capacity as platform practitioners, would have a legitimate need to dispense Schedule II-V controlled substances when they:
    • Expect to provide necessary services that connect patients with clinician practitioners via telemedicine for the diagnosis, treatment, and prescription of controlled substances;
    • Comply with federal and state regulations;
    • Oversee the clinician practitioner’s prescribing practices; and
    • Implement safeguards to prioritize patient safety and prevent diversion, abuse, or misuse of controlled substances.
  • Platform practitioners would need to attest to their legitimate need on their Special Registration application.

Special Registration numbers would be formatted distinctly, allowing pharmacists to easily differentiate between practitioners with a Special Registration and those with a traditional DEA registration.

Application Requirements

In the proposed rule, the DEA outlines several Special Registration application requirements. Notably, applicants would need to provide a physical address as their registered location, and platform practitioners would need to disclose all employment relationships, contractual relationships, and professional affiliations with any clinician practitioner with a Special Registration and online pharmacy.

State Telemedicine Registration

In addition to a Special Registration, clinician practitioners and platform practitioners, unless exempt, would still need to obtain a DEA registration in each state in which they intend to prescribe or dispense controlled substances to patients via telemedicine. However, in lieu of the traditional DEA registration, the proposed rule establishes a limited State Telemedicine Registration, which would be less expensive for clinician practitioners. The proposed fee is $50 for clinician practitioners, reflecting a significant reduction from the cost of a traditional DEA registration, and $888 for platform practitioners, which matches the cost of a traditional DEA registration. Similar to Special Registrations, State Telemedicine Registration numbers would be formatted distinctly, allowing pharmacists to easily differentiate between practitioners with a State Telemedicine Registration and those with a traditional DEA registration.

Requirements of the Proposed Rule

Telehealth Modality

Similar to the regarding telemedicine prescribing of buprenorphine, practitioners would be permitted to prescribe Schedule III-V controlled substances approved by the U.S. Food & Drug Administration to treat opioid use disorder via telemedicine (currently limited to buprenorphine) through an audio-only visit. (See our discussion on the DEA’s final buprenorphine rule here.) Audio-only visits would only be permitted if the practitioner has the capability to use audio-video, but the patient is either unable to use video or does not consent to it. However, unlike the final buprenorphine rule, treatment would need to be initiated through an audio-video visit, and the practitioner would need to have conducted at least one medical exam of the patient via audio-video. Prescriptions not meeting the criteria described above would only be able to be issued through an audio-video visit.

Schedule II Controlled Substances

Practitioners would only be permitted to prescribe Schedule II controlled substances via telemedicine if they are physically located in the same state as the patient at the time of the encounter when the prescription is issued. Additionally, the number of Schedule II controlled substances prescribed via telemedicine, averaged monthly, would be limited to less than 50% of the practitioner’s total Schedule II prescriptions (including both telemedicine prescriptions and non-telemedicine prescriptions).

PDMP Check

Effective immediately, if the proposed rule is finalized, practitioners with a Special Registration would need to check the patient’s controlled substance prescription data in Prescription Drug Monitoring Programs (PDMPs) of certain jurisdictions before issuing a prescription for controlled substances via telemedicine. The practitioner would need to review the PDMPs for any controlled substance prescriptions issued to the patient within the last year, or, if less than a year is available, for the entire available period. The relevant jurisdictions include:

• The state where the patient is located;
• The state where the practitioner is located; and
• Any U.S. jurisdiction with PDMP reciprocity agreements with either of the states above.

Three years after the effective date, before issuing a prescription for controlled substances via telemedicine, practitioners with a Special Registration would need to check the PDMPs of all U.S. jurisdictions for controlled substance prescriptions issued to the patient within the last year, or, if less than a year is available, for the entire available period. If there is no means to perform this nationwide PDMP check, the practitioner would continue performing the PDMP checks as described above. We note that there is currently no nationwide PDMP database in operation.

Additional Requirements and Commentary

The proposed rule also:

• Sets forth certain recordkeeping, patient identification verification, reporting, prescription, and e-prescribing requirements for those with Special Registrations;
• Notes that practitioners with Special Registrations would need to be located within the U.S. when issuing a prescription via telemedicine and would need to still comply with any applicable state requirements and restrictions regarding prescribing controlled substances;
• Emphasizes that once an in-person medical exam has been conducted, the practitioner and patient would no longer be considered to be engaged in the practice of telemedicine, and the requirements of the proposed rule would not apply; and
• Establishes reporting requirements for pharmacies filling Special Registration prescriptions.

A Brief History

The rule stems from the Ryan Haight Act, which amended the Controlled Substances Act to restrict practitioners from prescribing controlled substances unless the practitioner conducts an in-person examination of the patient. The Controlled Substances Act also requires practitioners obtain a separate DEA registration in each state where their patients are located. The Ryan Haight Act (at ) outlines seven exceptions under which practitioners may prescribe controlled substances via telemedicine without an in-person exam, one of which involves practitioners who have obtained a special registration. Congress expected the DEA to issue the special registration rule shortly after the Ryan Haight Act was signed into law in 2008. After years of DEA failing to do so, Congress and the White House signed the SUPPORT Act of 2018, a federal law that mandated DEA promulgate the special registration rule by October 2019. 

During the COVID-19 Public Health Emergency (PHE), the DEA issued letters on , and , granting temporary exceptions to the Ryan Haight Act and its implementing rules that enabled DEA-registered practitioners to prescribe controlled substances without an in-person exam and with a DEA registration in only one state. In March 2023, two months before the end of the PHE, the DEA proposed a rule on telemedicine prescribing of controlled substances, but the rule did not include a special registration framework and was not favorably-viewed. In response, the DEA quickly rescinded the proposed rule and extended the COVID-era flexibilities in May 2023 and again in October 2023. In June 2024, the DEA submitted a special registration rule for Office of Management and Budget clearance that was so unworkable for stakeholders that it was not published. Instead, the flexibilities were further extended in November 2024, and are now set to expire on December 31, 2025. (For more details, see our previous discussions on the DEA’s proposed rules for telemedicine prescribing of controlled substances and the first, second, and third temporary rules extending COVID-era flexibilities.)

Make Your Voice Heard

The DEA is soliciting comments until 11:59 p.m. ET March 18, 2025. Stakeholders may submit comments electronically or via regular or express mail to the following address:

Drug Enforcement Administration
Attn: DEA Federal Register Representative/DPW
8701 Morrissette Drive, Springfield, VA 22152

All correspondence, including attachments, must include a reference to “Docket No. DEA-407�.

Additionally, those with concerns about the proposed rule can share their feedback by contacting their White House.

What Comes Next

With the widespread frustration that met the March 2023 and June 2024 versions of this rule, there is little chance that the proposed rule will be finalized close to its current form. A key point of contention for stakeholders in the proposed rule is the nationwide PDMP check requirement, which is seen as overly burdensome given the absence of a nationwide PDMP database — a burden the DEA continues to underestimate. However, the future of the Special Registration is unclear due to the change in administration and potentially changing priorities and approaches.

President Trump’s first round of executive orders included a regulatory freeze. However, the does not affect the proposed rule. To influence the direction of the proposed rule, ATA Action has President Trump to prioritize the immediate withdrawal of it. If the proposed rule undergoes another set of revisions and round of notice-and-comment rulemaking, it is unlikely that practitioners will have access to a special registration in 2025. Without a special registration process this year, another extension of the DEA telemedicine flexibilities will be crucial. We will continue to closely monitor any developments regarding the special registration process.

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team.

A version of this article was published on page 16 of magazine’s February 2025 issue.

After much uncertainty, Congress has extended many Medicare telehealth flexibilities through March 31, 2025, in its . However, some important flexibilities, such as first-dollar coverage of telehealth services under high deductible health plans (HDHPs) and health savings accounts (HSAs), will expire on December 31, 2024.

Although the extension ensures continued access to telehealth for Medicare patients, the short duration of the extension leaves the future of telehealth for Medicare patients uncertain and creates ongoing unpredictability in reimbursement for telehealth providers. For patients, the loss of pre-deductible telehealth coverage under HDHPs will reduce access to telehealth and impact those who have avoided telehealth because of out-of-pocket expenses.

Below, we highlight some key provisions of the bill:

Flexibilities That Will Continue

• Originating Site: A patient’s home remains an eligible originating site (i.e., location of the patient) for any telehealth service, expanding beyond behavioral and mental health care services.
• Geographic Restrictions: Geographic restrictions, such as the requirement for patients to be located in rural areas, remain waived.
• Audio-Only: Audio-only communication remains a viable option for any telehealth service.
• Expanded Provider Types: Any health care provider who is eligible to bill Medicare for covered services may continue to provide and bill for telehealth services, expanding beyond the previously limited list of eligible provider types.
• In-Person Requirements: The requirement that tele-behavioral/mental health patients must have an in-person visit within six months of their initial telehealth visit and annually thereafter remains waived.
• Hospice Care: Telehealth remains a viable option for face-to-face encounters required for hospice care recertifications.
• Acute Hospital Care at Home: Hospitals continue to receive reimbursement for acute care services provided through telehealth to patients in their home.
• FQHCs and Rural Health Clinics: Federally qualified health centers (FQHCs) and rural health clinics remain eligible distant sites (i.e., location of the practitioner) for telehealth services.

Flexibilities That Will Expire

• Pre-Deductible Coverage: Telehealth services will no longer qualify for first-dollar coverage under HDHPs and HSAs.

Although Congress will need to revisit the telehealth flexibilities before they expire again, certain provisions have already been made permanent and are unlikely to change. These include:

• A patient’s home as an eligible originating site for behavioral and mental health services.
• The removal of geographic restrictions for patients receiving behavioral and mental health services.
• The availability of audio-only communication for practitioners providing behavioral and mental health services.

A Brief History

Congress first implemented Medicare telehealth flexibilities during the COVID-19 PHE in 2020. The flexibilities were later extended, or made permanent in certain cases, through the (CAA), , and . For more details, refer to our prior discussions detailing the extensions provided in the 2022 CAA and 2023 CAA. Initially, the mid-December 2024 draft of the year-end spending bill extended all flexibilities in place before January 1, 2025, for an additional two years. However, just days before the government was set to shut down after December 20, 2024, the plan abruptly changed. The House and Senate debated several versions of the bill, one of which omitted the flexibilities altogether, before reaching an agreement.

Make Your Voice Heard

As Congress again approaches the expiration of temporarily extended Medicare telehealth flexibilities, it will again debate whether to extend them or make them permanent. Congress may also consider whether to retroactively extend the flexibilities set to expire at the end of 2024. Telehealth has always been a bipartisan issue, and stakeholders are encouraged to contact their and the incoming Trump administration to advocate for continued access.

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team

The Drug Enforcement Administration (DEA) just released a temporarily extending the COVID-era flexibilities for prescribing controlled substances via telemedicine. This third extension continues the “full set� of telemedicine prescribing flexibilities, referencing the two DEA letters that authorized telemedicine waivers, with a new expiration date of December 31, 2025. Practitioners may continue to:

• Prescribe Schedule II-V controlled substances via telemedicine without having conducted an in-person evaluation of the patient, if certain conditions are met (see the DEA’s Ìý±ô±ð³Ù³Ù±ð°ù).
• Maintain a DEA registration in at least one state (see the DEA’s Ìý±ô±ð³Ù³Ù±ð°ù).

Without this extension, the telemedicine flexibilities were set to expire at the end of 2024. 

In the new rule, the DEA acknowledged many patients and practitioners have come to depend on telemedicine for prescribing controlled substances. Allowing these flexibilities to expire on December 31, 2024, DEA stated, would disrupt access to care, and potentially harm patients who rely on telemedicine for their medications. The potential reduction in access to care is contrary to the public interest, stated the DEA, particularly if patients are unable to obtain necessary medications.

The DEA limited the extension to one year to avoid incentivizing the creation of new telemedicine companies that might misuse the flexibilities for improper prescribing practices. The one-year extension is intended to give the DEA time to finalize a set of regulations for telemedicine prescribing of controlled substances that will account for feedback from public comments, the Telemedicine Listening Sessions, Tribal Consultations, and meetings held under Executive Order 12866. The DEA plans to issue the final regulations with enough lead time to allow practitioners to come into compliance with any new requirements before the telemedicine prescribing flexibilities expire on December 31, 2025.

A Brief History

The rules stem from the Ryan Haight Act, which amended the Controlled Substances Act to restrict clinicians from prescribing controlled substances unless the clinician conducts an in-person exam of the patient. The Controlled Substances Act also requires clinicians obtain a separate DEA registration in each state where their patients are located. Congress expected the DEA to issue the special registration rule shortly after the Ryan Haight Act was signed into law in 2008. After years of DEA failing to do so, Congress and the White House signed the SUPPORT Act of 2018, a federal law that mandated DEA promulgate the special registration rule by October 2019. Five years later, DEA has yet to release the rule.

During the COVID-19 Public Health Emergency (PHE), the DEA enacted certain flexibilities allowing clinicians to prescribe controlled substances without an in-person exam and with a DEA registration in just one state. In February 2023, two months before the end of the PHE, the DEA proposed a rule on telemedicine prescribing of controlled substances, but the rule was not favorably-viewed. The DEA received tremendous criticism from private industry and public officials with the proposed rule netting a record-breaking 38,000 public comments, nearly all of which were scathingly critical of the rule and how it failed to recognize how medical services are actually delivered by clinicians and pharmacies. Following the public backlash, the DEA quickly rescinded the proposed rule and extended the COVID-era flexibilities (once in May 2023 and again in October 2023). The two extensions were intended to provide additional time for the DEA to draft a workable rule on a special registration for telemedicine prescribing of controlled substances. (For more details, see our previous discussions on the DEA’s proposed rules for telemedicine prescribing of controlled substances and first and second temporary rules extending COVID-era flexibilities.)

Make Your Voice Heard

Although stakeholders have secured an extension to the telemedicine prescribing flexibilities, there is still more to do to ensure permanent access to controlled medications. Stakeholders should continue to make their voice heard so the DEA will:

• Create a private-public taskforce composed of stakeholders and practicing clinicians who prescribe via telemedicine to provide essential feedback to the DEA so it is better equipped to draft a new proposed rule establishing the special registration process.
• Publish the new proposed rule early in 2025 so the rule has adequate time to go through public comment and the administrative rulemaking process before the expiration of the flexibilities.

People who care about this issue can share their concerns via the following channels:

• Email the DEA
• Send a letter or email to:
  • ’s office
  • ’s office
  • ’s office

Conclusion

Given how long stakeholders have been waiting for a special registration process, it remains to be seen what the DEA’s proposed rule for 2025 will entail. We will continue to closely monitor the release of this new proposed regulation in the coming year.

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team.

Congress returned to Washington this week with just five weeks left in this year’s legislative calendar. With a Continuing Resolution (CR) that expires December 20, 2024, either a year-end spending package or a new Continuing Resolution will need to be passed to continue funding the government. There are several health policies that may be included in this package, including policies expiring at the end of the year. Must-pass items, such as extensions for Medicare COVID-era telehealth flexibilities and policy changes that enjoy broad bipartisan, bicameral support, such as Pharmacy Benefit Manager (PBM) Reform and BIOSECURE, are on the docket for consideration. 

Must-Pass

Telehealth Extension: Medicare Flexibilities

The Issue

Medicare telehealth flexibilities put in place during the COVID-19 pandemic will expire at the end of this year following a two-year extension in the Consolidated Appropriations Act of 2023. Prior to the pandemic, telehealth coverage was only available with restrictions in rural areas. These flexibilities include a moratorium on required in-person visit within six months of a preliminary telehealth appointment for mental health services; an exemption to geographic site restrictions, which greatly benefits rural and urban patients; inclusion of all Medicare beneficiaries to receive telehealth services; and authority to provide audio-only services. 

Potential Congressional Fixes

Several bills have been introduced to extend these flexibilities, and have moved through committees of jurisdiction. A few have the potential to land in a year-end package, including:

• , “The Telehealth Modernization Act of 2024,â€� introduced by Reps. Buddy Carter (R-GA-01) and several bipartisan members last March, was voted unanimously out of the House Energy and Commerce (E&C) Committee in August. Initially, the bill included a permanent extension of flexibilities, however it was amended to a two-year extension with pay fors via PBM reform. 
• “The Telehealth Modernization Act,â€� introduced by Sens. Tim Scott (R-SC) and 8 other bipartisan Senators, was referred to Senate Finance back in March. Much like its original counterpart, this bill seeks to make permanent Medicare telehealth flexibilities, though no additional actions have been taken yet. 
• , “Preserving Telehealth, Hospital, and Ambulance Access Act,â€� introduced by Reps. David Schweikert (R-AZ-01) and Mike Thompson (D-CA-04), would, among other things, extend key flexibilities through December 2026. This bill was voted out of House Ways and Means Committee in May.

A short-term extension or even permanence of these flexibilities has heavy bipartisan support in both chambers and is likely to be addressed before expiring. 

Voucher for Pediatric Rare Disease Drugs Extension

The Issue

The Rare Pediatric Disease Priority Review Voucher (RPD PRV) is set to expire at the end of the year without a further extension or reauthorization (it was already extended temporarily in the Sept. 30 CR). This 12-year-old program offers incentives to companies for development of therapies for rare pediatric diseases by providing vouchers for a faster U.S. Food and Drug Administration (FDA) review. The program was created to incentivize developing therapies for rare pediatric diseases, as the patient population is typically too small to attract investment. These vouchers can be used either by the recipient or sold to another company for use and are highly sought after with less than 100 ever awarded.

Potential Congressional Fixes

/, “Creating Hope Reauthorization Act of 2024,� is bipartisan legislation introduced in both chambers earlier in 2024 that would extend until FY2029 the voucher program. H.R. 7384, introduced by Rep. Michael McCaul (R-TX-10) and five additional bipartisan sponsors, and S. 4583, introduced by Sen. Bob Casey (D-PA) and three additional bipartisan cosponsors, were referred to E&C and Senate Health, Education, Labor, and Pensions (HELP), but neither has made any additional progress. With little movement on reauthorization bills, it is likely that an additional extension will be needed to avoid expiration. 

Other Expiring Provisions

• Medicare
  1. Extenders
     1. Medicare Low-Volume Payment Adjustment
     1. Medicare-Depending Hospital Program
     1. Medicaid Disproportionate Share Hospital (DSH) Payment Cuts Delay
  1. Medicare Pay As You Go (PAYGO) Cut
  1. Funding for assistance for low-income programs
• Community Health Center Fund  
• Pandemic and All-Hazards Preparedness Act (PAHPA) Reauthorization
• National Health Service Corps
• Advanced Alternative Payment Model Bonus Payment
• Dr. Lorna Breen Health Care Provider Fund

May-Pass

PBM Reform

The Issue

An issue with strong bipartisan, bicameral agreement, reform to PBM practices is at the top of the “may-pass� list. In July 2024, the House Oversight Committee released a detailing how the largest PBMs control more than 80% of the market and are vertically integrated with health insurers, pharmacies, and providers. The result, the report, notes, is that patients are seeing significantly higher costs with fewer choices and worse care. Lawmakers are seeking to require additional transparency into the process, removing vertical integration to create more competition, targeting spread pricing and preferential treatment for drugs that yield higher rebates, and, ultimately to reduce prescription drug costs for patients.

Potential Congressional Fixes

Key committees, including E&C, House Ways and Means, House Oversight, House Judiciary, Senate HELP, Senate Finance, and Senate Judiciary have all held hearings about PBM Reform, with several pieces of legislation making it through markup, and two passing through the House thus far. The legislation most likely to be included in a year-end package includes:

• , “Lower Costs, More Transparency Act,â€� passed the House with strong bipartisan support in December 2023. Introduced by E&C Chair Cathy McMorris Rodgers, this bill would, among other things:
  • Require PBMs to file semiannual reports to health plan sponsors on spending, rebates, and fees associated with covered drugs. Require PBMs to allow audits on certain claims and cost information.
  • Prohibit spread pricing and require pass-through pricing models for payment arrangements with PBMs under Medicaid.
• , “Accelerating Kids’ Access to Care Act,â€� was introduced by Reps. Lori Trahan (D-MA-03) and Mariannette Miller-Meeks (R-IA-01) in July 2023 and passed out of the House by voice vote in September 2024, sending it to Senate Finance for consideration. Among other provisions, this bill requires pass-through pricing models and prohibits spread pricing for payment arrangements with PBMs under Medicaid.
• , “Modernizing and Ensuring PBM Accountability Act,â€� introduced by Senate Finance Chair Ron Wyden and Ranking Member Mike Crapo in September 2023 and voted out of committee three months later in December, would prohibit PBM compensation in Medicare from being tied to drug prices and create an independent audit and enforcement measure to increase PBM transparency, among other provisions. Senator Wyden is one of many lawmakers to note his intentions to focus on PBM Reform going into the remainder of the 118^th °ä´Ç²Ô²µ°ù±ð²õ²õ.Ìý
• /, “Medicare PBM Accountability Act,â€� introduced in the House by Rep. Greg Landsman (D-OH-01) in September 2023 and in the Senate by Sen. Catherine Cortez Masto (D-NV) in July 2023, would establish stricter reporting requirements for PBMs under Medicare Advantage and the Medicare prescription drug benefit program. This bill has made more traction in the House, passing out of E&C by a vote of 44-0.
• , “Pharmacy Benefit Manager Reform Act,â€� introduced by HELP Chair Bernie Sanders and three additional bipartisan lawmakers in April 2023, passed out of Committee in June 2023. This bill would put stricter requirements in place for PBMs regarding services provided to health insurance plans. The legislation would:
  • Prohibit spread pricing.Require PBMs to report to insurance plan sponsor information about their services and further provide a biannual report to the sponsor with information about pharmacies that are owned by the PBM.
  • Require PBMs to remit to the sponsor all rebates, fees, alternative discounts, and anything else received from a drug manufacturer.

BIOSECURE Act

, “BIOSECURE Act,â€� introduced by Rep. Brad Wenstrup (R-OH-02) and Raja Krishnamoorthi (D-IL-08) in May 2024, would prohibit federal agencies from procuring or obtaining any biotechnology equipment or service produced or provided by a biotechnology company of concern. This bill passed the House with a bipartisan vote of 306-81 and was received by the Senate for consideration in early September. With strong support in both chambers, there is a high likelihood that it will be signed into law by the end of the year. BIOSECURE will have lasting impacts on the pharmaceutical and biotechnology companies, and with potential retaliation from the Chinese government. Learn more about BIOSECURE in an in-depth Â鶹´«Ã½ article “BIOSECURE Act: Anticipated Movement, Key Provisions, and Likely Impact.â€� 

Medicare Physician Payment Fix

The Issue

Following the release of the CY2025 Medicare Physician Fee Schedule (Fee Schedule) Proposed Rule last July with a provision that proposes 2.8% in Medicare physician cuts, stakeholders and lawmakers alike have pushed back on what would be the fifth consecutive year of proposed cuts to the conversion factor. Nearly were submitted on the proposed rule, many from big name provider groups like the American Medical Association and American Hospital Association criticizing the Centers for Medicare and Medicaid Services (CMS) for not adjusting payments based on inflation. In early October, a House majority comprised of 233 bipartisan members signed a letter to House leadership urging a provision in a year-end spending package that protects physicians from these payment cuts.

Potential Congressional Fixes

In late October, was introduced by a bipartisan group of lawmakers. This bill would provide physicians with a 4.73% payment increase in 2025 to offset the 2.8% Medicare cuts in the Medicare Physician Fee Schedule Final Rule. Sponsors include Reps. Greg Murphy (R-NC), Mariannette Miller-Meeks (R-IA), Larry Bucshon (R-IN), John Joyce (R-PA), Jimmy Panetta (D-CA), Ami Bera (D-CA), Raul Ruiz (D-CA), and Kim Schrier (D-WA).  It is possible Congress will include a portion of this payment increase in a year end spending package.

Even prior to the proposed rule, committees of jurisdiction including House Energy & Commerce, House Ways & Means, and Senate Finance, along with the House “Docs Caucusâ€�, have focused efforts on Medicare physician payment reform throughout this session. Legislation introduced includes:  

• , “Physician Fee Stabilization Act,â€� in August by Sens. John Boozman (R-AR) and Peter Welch (D-VT – original co-sponsor), and referred to the Senate Finance Committee, would update the budget neutrality threshold under the Fee Schedule, last updated in 1992, to $53 million with an increase every five years. 
• , “Physician Fee Schedule Updates and Improvements Act,â€� introduced in Dec. 2023 by Rep. Mariannette Miller-Meeks (R-IA-01) and a list of bipartisan members, would also increase the budget neutrality from $20 million to $53 million. This bill passed out of E&C by a vote of 64-0.
• , “Strengthening Medicare for Patients and Providers Act,â€� introduced in April 2023 by Rep. Raul Ruiz (D-CA-25) with original co-sponsorship from Reps. Larry Bucshon (R-IN-08), Amy Bera (D-CA-06), and Mariannette Miller-Meeks (R-IA-01), would shift the payment rate by providing an annual update tied to inflation based on the Medicare Economic Index (MEI). This bill was referred to E&C and has amassed 170 cosponsors.

In March of this year, Congress was able to partially reverse a proposed 3.37% physician payment cut in the CY2024 Fee Schedule with the passage of the Consolidated Appropriations Act of 2024. However, this is a temporary fix, lasting through the end of 2024. Permanent reform has strong bipartisan support and could see movement in the next Congress.

Â鶹´«Ã½ is prepared to help you navigate these and other important legislative considerations related to business and industry. Please reach out to the authors, your Â鶹´«Ã½ relationship partner, our Health Care & Life Science Sector, or to our Government Solutions and Health Care Practice Groups with any questions.

In the wake of the U.S. Drug Enforcement Agency’s (DEA) notice of a forthcoming with a third extension of flexibilities related to telemedicine prescribing of controlled substances, some industry stakeholders anticipate the rule will extend the current DEA telemedicine prescribing flexibilities for at least another year to avoid the Telehealth Cliff. However, the proposed rule has not yet been made public and significant questions remain as to the rule’s specifics. The rule is expected to be released and available for public review before the end of the year.

In a recent episode of the podcast, Nathaniel Lacktman, chair of the firm’s national Telemedicine & Digital Health Industry Team and member of the American Telemedicine Association Board of Directors, joined host and Zivian Health founder, to explore the latest updates on DEA regulations, the future of telemedicine, and how health systems, hospitals, and startups can innovate while staying compliant.

The conversation opened with a brief history of the intersection of the DEA’s rules and the 2008 Ryan Haight Act, which amended the Controlled Substances Act to restrict clinicians from prescribing controlled substances unless the clinician conducts an in-person exam of the patient. Lacktman highlighted the DEA special registration exemption that offered a way for eligible health care providers to deliver patients flexibility through prescribing without an in-person exam.

“We are nearing the end of 2024 – 16 years after the Ryan Haight Act was signed into law – and the DEA has not issued a regulation to activate the special registration for telemedicine,â€� Lacktman commented. “It’s frustrating.  Someone who operates an illegal internet pharmacy or pill mill is not going to follow the DEA rules anyhow, so that operator does not care whether or not a viable special registration exists,â€� explaining how those most affected are telemedicine companies, hospital systems, academic medical centers, and community mental health centers who need and want to service their patients responsibly, and care about compliance with these laws. “It is that cohort of clinicians, arguably the most well-equipped, most well-intended, who are experiencing harm from the lack of a special registration,â€� he emphasized, adding that in this delay harms “the types of clinicians who are most committed to caring for these patients.â€�

The DEA received backlash in late August 2024 following the unveiling of the DEA’s internal plans to release a regulation with devastating consequences for the telemedicine industry and the patients it serves.  It is evident certain parts of the rule were included with the intent of making it functionally impossible to practice telemedicine. Particularly glaring was the requirement for telemedicine providers to conduct half of their patient exams in-person.  Another requirement was checking the prescription drug monitoring programs (PDMPs) of all 50 states – even though some states do not even have a PDMP – before a prescription can be issued for a patient.

The delays and rough going have led some stakeholders to question if the DEA, historically with a policing and anti-diversion mission, is the appropriate agency to make rules on the clinical practice of medicine (medical boards are not tasked with policing illegal drug trade).  An informed, thoughtful, and patient-oriented approach coupled with a beneficial and important guardrails against illegal diversion would offer a better path forward for the telemedicine industry.  A series of public-private workgroups, where expertise can be combined and ideas freely discussed, may be best forum to accomplish the development of a telemedicine special registration rule.

“We should allow legitimate practitioners, and the patients who rely on them, to prescribe the types of medications their patients need to live healthy lives,� he added.

Want to Learn More?

• Listen to the full Health & Hype interview at .
• New DEA Rule Expected to Extend Controlled Substance Telemedicine Prescribing Flexibilities Through 2025
• 50-State Survey of Telehealth Insurance Laws

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team.

After considerable pressure from both Congress and the White House, the Drug Enforcement Administration (DEA) submitted a regarding flexibilities on telemedicine prescribing of controlled substances on October 11, 2024. Specifics of the proposed rule are not yet available, but we anticipate the rule will extend the current DEA telemedicine prescribing flexibilities for at least one more year, possibly two. The proposed rule is expected to be released and available for public review before the end of the year and should extend both the in-person exam waiver and the state-by-state DEA registration waiver. 

In late August 2024, POLITICO broke news on the to release an unworkable regulation that would render telemedicine prescribing of controlled substances functionally impractical. Although the draft rule was not publicly released, reporters uncovered how the U.S. Department of Health and Human Services strongly opposed the DEA’s draft, having formally objected to its release at least three times and lodging approximately 400 line-item concerns regarding it. After the news broke, stakeholders were stunned and disappointed. Soon after, patients, clinicians, and leading advocacy associations such as the American Telemedicine Association, , and the Alliance for Connected Care, took action through , and a series of scathing letters from and urged the DEA to honor its to issue a set of telemedicine regulations before the end of 2024.

Now, with insufficient time before the end of the year to enact a special registration rule, the only path forward to avoid the Telehealth Cliff is to extend the flexibilities further. This will allow time for the DEA to draft a new proposed rule (ideally doing so in collaboration with a taskforce comprised of practicing clinicians and industry stakeholders). Without an extension, the flexibilities that have increased access to health care for individuals in rural and underserved communities over the past four years will disappear after December 31, 2024, resulting in thousands of patients facing the Telehealth Cliff and losing access to critical medications.

A Brief History

The rules stem from the Ryan Haight Act, which amended the Controlled Substances Act to restrict clinicians from prescribing controlled substances unless the clinician conducts an in-person exam of the patient. The Controlled Substances Act also requires clinicians obtain a separate DEA registration in each state where their patients are located. Congress expected the DEA to issue the special registration rule shortly after the Ryan Haight Act was signed into law in 2008. After years of DEA failing to do so, Congress and the White House signed the SUPPORT Act of 2018, a federal law that mandated DEA promulgate the special registration rule by October 2019. Five years later, DEA has yet to release the rule.

During the COVID-19 Public Health Emergency (PHE), the DEA enacted certain flexibilities allowing clinicians to prescribe controlled substances without an in-person exam and with a DEA registration in just one state. In February 2023, two months before the end of the PHE, the DEA proposed a rule on telemedicine prescribing of controlled substances, but the rule was not favorably-viewed. The DEA received tremendous criticism from private industry and public officials with the proposed rule netting a record-breaking 38,000 public comments, nearly all of which were scathingly critical of the rule and how it failed to recognize how medical services are actually delivered by clinicians and pharmacies. Following the public backlash, the DEA quickly rescinded the proposed rule and extended the COVID-era flexibilities (once in May 2023 and again in October 2023). The two extensions were intended to provide additional time for the DEA to draft a workable rule on a special registration for telemedicine prescribing of controlled substances. (For more details, see our previous discussions on the DEA’s proposed rules for telemedicine prescribing of controlled substances and first and second temporary rules extending COVID-era flexibilities.)

What Happens if the Flexibilities Expire?

If the flexibilities expire, clinicians planning to prescribe controlled substances via telemedicine must:

• Meet one of the seven (narrow) exceptions under the Ryan Haight Act or conduct an in-person exam of the patient; and
• Obtain a separate DEA registration in every state in which their patients are located.

These requirements must be met even if the clinician has been treating the patient since 2020 under the COVID-era flexibilities because DEA has stated there is no “grandfathering� provision under the law that would allow clinicians to continue to prescribe for these patients after the flexibilities expire. The stakes are high for clinicians, as failure to comply with these requirements constitutes a per se violation of the Controlled Substances Act and may lead to criminal or civil penalties and revocation or suspension of the clinician’s DEA registration. Any adverse action taken against the clinician’s DEA registration would trigger disclosures to state professional licensing boards, Medicare, Medicaid, and likely the clinician’s employer.

Make Your Voice Heard

Although there is no published rule to comment on yet, in order to maintain patients’ ongoing access to controlled medications, stakeholders should continue to make their voice heard so the DEA will:

• Extend the telemedicine prescribing flexibilities for two more years.
• Create a private-public taskforce composed of stakeholders and practicing clinicians who prescribe via telemedicine to provide essential feedback to the DEA so it is better equipped to draft a new proposed rule establishing the special registration process.
• Publish the new proposed special registration rule early in 2025 so the rule has adequate time to go through the administrative rulemaking process before the expiration of the flexibilities.

People who care about this issue can share their concerns via the following channels:

• Email the DEA
• Send a letter or email to:
  • ‘s office
  • ’s office
  • ‘s office
• Sign for Women’s Health access urging the DEA to extend the telemedicine prescribing flexibilities
• Sign the calling on Congress and the Biden Administration to support extending the telemedicine prescribing flexibilities

Conclusion

We will continue to monitor the rule development and provide updates. 

For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visit Â鶹´«Ã½â€™s Telemedicine & Digital Health Industry Team.

Patients and health care professionals have been quick to adopt telemedicine and digital health technologies. In the last five years, the legal landscape for telehealth insurance coverage and reimbursement has expanded in several ways:

• More organizations are implementing and expanding robust virtual care programs to supplement their traditional in-person offerings. 
• In rural areas, phone coverage helps those with limited access to broadband internet and in-person care.
• With telehealth and digital health resources, patients also get a boost in mental health care because these tools help address the imbalance in supply and demand.
• More states changed their laws to prohibiting exclusive telehealth platform arrangements, increasing competition among software companies and allowing individual clinics and hospitals to make decisions based on what works for them and their patients.
• There has been progress with payment parity — reimbursing providers at the same rate for telehealth as in-person, but there is still a way to go.

All of this together is steady progress, and it codifies by law improvements that patients have loved. Unfortunately, the market cannot rely on the health care industry to make these changes voluntarily — the laws passed by individual states serve as the bridge to solidify telehealth-based services as a core health insurance benefit for the patients who use them.