As federal operations resume following the recent shutdown, agencies are preparing actions that will directly affect telehealth regulation and reimbursement. Medicare clinicians who continued providing virtual care during the 42-day funding lapse are expected to receive delayed payments, while the Drug Enforcement Administration (DEA) signals it is ready to extend pandemic-era prescribing authorities for controlled substances.
Medicare telehealth providers treated patients throughout the shutdown period even though Congress allowed funding to expire. These clinicians are now waiting for the Centers for Medicare & Medicaid Services to issue instructions on how reimbursement claims should be processed following the interruption.
Separately, the DEA posted a notice indicating that it intends to renew temporary prescribing flexibilities once again. The current extension, issued in November 2024, is set to end on December 31. The Department of Justice has not yet released the details of the proposal, listed as the “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications.” According to one lobbyist, the upcoming version is expected to maintain the existing structure for another year.
These temporary policies, in place for nearly six years, allow DEA-registered clinicians to prescribe Schedule II–V controlled substances using telehealth without requiring patients to visit a provider in person. It remains undetermined how DEA Administrator Terry Cole or Health and Human Services Secretary Robert F. Kennedy Jr. plan to design a long-term regulatory framework for remote prescribing.
Industry sources note that the Make America Healthy Again movement holds varied positions on controlled substances, supporting hormone replacement therapies and psychedelics while expressing negative views of medications used for attention-deficit/hyperactivity disorder and cannabis. This mix of perspectives adds uncertainty as agencies work toward permanent rules.
A renewed extension would enable telehealth prescribers to continue operating under existing regulations while the DEA finalizes a long-term approach. Under the previous administration, the agency faced ongoing questions about whether Schedule II medications, such as Adderall or oxycodone, should remain eligible for prescribing without in-person examinations. The DEA’s statutory mandate to prevent diversion and misuse has contributed to its caution regarding remote access to drugs with higher abuse risk.
Just before the administration transition, the DEA released a rule that would have divided telemedicine providers into three regulatory categories and significantly reduced access to Schedule II medications. That rule never took effect. When the American Telemedicine Association reviewed the proposal, its senior vice president of public policy, Kyle Zebley, said, “Early indications suggest the proposed rule includes elements that represent significant operational challenges.”
A former DEA official separately stated that the unpublished rule could have severely affected the telemedicine sector by disrupting established prescribing practices. As agencies prepare their next steps, professional associations and telehealth organizations continue to advocate for regulations that would maintain the ability to prescribe controlled substances remotely without mandatory in-person visits. They argue that physicians are equipped to determine when an in-person evaluation is required.
