Updated on September 29, 2025

The Consolidated Appropriations Act of 2023 allowed multiple flexibilities in behavioral or mental telehealth. Congress extended some of these telehealth flexibilities under the Medicare during the COVID-19 PHE through 2025. However, the provisions affecting telehealth services—specifically those permitting patients to access telehealth without the requirement of an in-person visit every six months—are set to expire on September 30, 2025.

The Ryan Haight Act amended the Controlled Substances Act to restrict clinicians from prescribing controlled substances unless the clinician conducts an in-person exam of the patient. During the COVID-19 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. This flexibility is set to expire December 31, 2025.

The potential end of these flexibilities will mark a significant shift in the landscape of telemedicine. To prepare APA members for this shift, our Committee on Telepsychiatry provides you with the following guidance:

Practice Considerations

• Start your planning process early.
  • There may be additional needs for patients with co-occurring medical or surgical conditions who would be at increased risk for poor outcomes.
• Review your current patient list to identify those who may be affected by this change.
  • Collaborate with primary care physicians in your patient's local area.
  • Psychiatrists may need to be in direct contact with a patient’s specialty provider (i.e., oncologist, rheumatologist, etc.) rather than their PCP if the psychiatrist is providing psychiatric consultation or care for a patient requiring specialty service.
  • The APA Find a Psychiatrist provides a way to search by zip code, city, and state to help find a psychiatrist in the local area.
  • Provide patients with information about local support groups and peer support services.
• Consider adjustments to scheduling and staffing to accommodate more in-person appointments.
• Develop a communication plan to inform patients about the potential changes and discuss their options.
• Update telehealth and in-person policies, protocols, procedures, and safety measures to align with the new requirements.
  • Review the APA such as the Telepsychiatry Toolkit & the Resource Document on Best Practices in Sychronous Videoconferencing-Based Telemental Health
• Ensure that all telehealth sessions are documented accurately and comply with any existing regulations.
• Stay up-to-date on payer policies as some may change coverage for telehealth services.
  • Center for Connected Health provides a guide on Medicare billing (.pdf).

The time to plan and communicate is now. There is still uncertainty about the extension of telemedicine flexibilities going into 2026, including the tele-prescribing of controlled medications. APA will continue to provide updates as information becomes available.