Jim Sharp • December 3, 2025

DEA Releases Fourth Temporary Extension of Telemedicine Flexibilities

Author

Jim Sharp

Date

December 3, 2025

Share

On November 10, 2025, the U.S. Drug Enforcement Administration (DEA) posted a fourth temporary extension of the COVID-19 telemedicine flexibilities for prescribing controlled substances. These flexibilities were set to expire at the end of the year. Although the DEA has not yet released the full text of the extension — including how long it will last. At this point, the final rule is still pending regulatory review. Historically, extensions have added a year of continued flexibility, though this extension could be shorter. For context, the previous extension, issued in November 2024, extended the telemedicine allowances through December 31, 2025. Until the fourth extension rule is approved and the complete text published, the duration and any potential policy adjustments remain unknown.


As background, permanent federal law under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 largely prohibits the prescribing of controlled substances without an initial in-person examination. While the statute outlines several exceptions under the defined “practice of telemedicine,” these apply primarily when a patient is located in a hospital or clinic or in the presence of another practitioner. As a result, these exceptions do not cover the routine model of telehealth widely used today, in which the patient (and sometimes the provider) participate from home settings. Importantly, the in-person requirement under the Ryan Haight Act applies only to the initial visit, and the DEA has never required subsequent in-person encounters. While the full details are not yet available, it is likely that the forthcoming temporary extension will mirror previous ones by continuing to suspend the initial in-person visit requirement for the period of the extension.


It is important to note that these DEA extensions affect only federally-controlled substance prescribing rules. States maintain their own requirements, which may include stricter requirements for in-person visits prior to the prescribing of controlled substances. Please check the Online Prescribing category of CCHP’s Policy Finder to reference state specific requirements.


Additionally, the DEA’s in-person prescribing requirement is separate from Medicare’s policy requiring an in-person visit within six months prior to an initial telehealth mental health service and annually thereafter. That Medicare mental health requirement — often confused with the DEA’s prescribing standard — is tied to Medicare reimbursement rules and applies only to Medicare beneficiaries and providers seeking reimbursement for mental health services through Medicare if their situations do not meet certain exceptions, not to all patients. Additionally, this Medicare in-person visit requirement is currently waived until January 30, 2026 (as passed in the most recent government funding bill), whereas the DEA’s in-person requirement, which is the topic of this particular newsletter and the new fourth extension rule, governs all practitioners prescribing controlled substances nationwide, regardless of payer.

_________________________________________________________________


If RCPA members have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

< Previous Post

Next Post >
PA ODP logo with dark blue border

ODP Updates the MAAC on Paid Relative Caregiving & Travel Limitations

By Tim Sohosky • May 29, 2026
On Thursday, May 28, the Office of Developmental Programs (ODP) provided an update to the Medical Assistance Advisory Committee (MAAC) regarding current policies and upcoming regulatory changes following a recent Commonwealth Court decision. On February 17, 2026, the PA Commonwealth Court issued a decision in Dunkelberger v. Department of Human Services that determined that ODP’s limitations on provider model services (specifically the 40/60-hour caps and 90-day travel maximums) were null and void. The decision was based on process rather than policy validity; the Court found that these limitations were not properly promulgated as regulations in accordance with the Commonwealth Documents Law and Regulatory Review Act. To maintain a balanced approach between flexibility and oversight, ODP is moving forward with the following actions: Regulatory Amendments: ODP will amend regulations to establish formal authority for setting service delivery limits that support individual welfare and program integrity. Self-Directed Model Agreements: ODP has already modified agreements for self-directed models to clarify limits on overtime, combined relative service provision, and travel restrictions. Travel Restrictions: Due to the inability to monitor services effectively over long distances, service provision will now be limited to Pennsylvania and contiguous states. Waiver Changes: ODP will seek modifications through the amendment process to the Consolidated, P/FDS, Community Living, and Adult Autism Waivers to include: New requirements for agencies providing IHCS and Companion services to disclose a DSP's relationship to participants; and Strengthened programmatic oversight and integrity measures. Life Sharing Alternative: For participants requiring more than 60 hours of paid care from a relative, the Life Sharing (24/7) service model remains the recommended alternative. ODP anticipates a public comment period for these proposed waiver changes beginning in January 2027.
Two men with intellectual disabilities working happily on a tablet.

Shapiro Administration's Strategic Investments in ID/A Community Lead to Highest Number of Pennsylvanians Ever Served in HCBS

By Tim Sohosky • May 28, 2026
Press Release from DHS : Published May 27, 2026
Yellow screen with the words

ODP Provides Updates to PBC 2026/27 Residential Pay-for-Performance

By Cathy Barrick • May 28, 2026
The Office of Developmental Programs (ODP) has shared ODPANN 26-039 . The purpose of this communication is to provide updated details about the Residential Performance-Based Contracting (PBC) Pay-for-Performance (P4P) initiatives for Fiscal Year 2026/27. Updates are provided in red . Please review the announcement for more details. Visit here to access the Pay for Performance (P4P): Residential Rural Capacity Expansion Plan template .