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  • CMS Telehealth Guidance, Capitol Hill Discussions & Nutrition Policy Momentum

    Center for Connected Health Policy

    CMS Updates Mental Health & Substance Use Disorder Telehealth Coverage Guidance
    The Centers for Medicare and Medicaid Services (CMS) has released a revised version of its Medicare & Mental Health Coverage booklet, incorporating several important updates related to telehealth and digital mental health services. Notable changes include notating telehealth coverage for caregiver training, depression screening, and tobacco cessation counseling. In addition, CMS added new HCPCS/CPT codes eligible for telehealth and outlined coverage criteria for digital mental health treatment (DMHT) devices when used “incident to” behavioral health services.

    Due to the possibility that the current Medicare telehealth waivers are not extended or changed, the guidance confirms that starting October 1, 2025, Medicare will require an in-person visit within six months before initiating telehealth-based mental health services, with follow-up in-person visits at least every 12 months. For rural health clinics (RHCs) and federally qualified health centers (FQHCs), this requirement is delayed until January 1, 2026 for services delivered to patients in their homes. However, CMS does not mention in the document that current permanent federal law still allows Medicare mental health services to be delivered without an in-person visit if the patient is located at an eligible facility in a geographically rural area or a rural health professional shortage area. Providers can check geographic eligibility using HRSA’s telehealth tool. In-person visit exemptions also remain in place for patients with substance use disorder and co-occurring mental health conditions. Finally, an exception to the subsequent 12 month in-person requirement described in the 2022 Final Physician Fee Schedule is also not explicitly addressed by CMS in the booklet – specifically that the requirement can be waived if the patient and practitioner agree that the risks and burdens associated with an in-person service outweigh the benefits of an in person visit. 

    Additionally, the updated guidance affirms that opioid treatment programs (OTPs) may deliver intake activities, assessments, counseling, and even the initiation of buprenorphine treatment via audio-video telehealth, or audio-only when video is unavailable or not feasible. Notably, OTPs can use HCPCS code G2076 to bill for methadone initiation when conducted with audio-only devices—so long as a licensed practitioner is physically present with the patient. Related updates were also made to CMS’s Substance Use Screenings and Treatment booklet, which now clarifies that providers may prescribe controlled substances like buprenorphine via telehealth through December 31, 2025. However, the booklet does not mention that prescribing controlled substances via telehealth remains permissible after December 31, 2025, provided an initial in-person visit has occurred, a longstanding permanent law established under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. It also omits reference to the Drug Enforcement Agency (DEA)’s final rule, effective January 1, 2026, which permanently allows buprenorphine to be prescribed via telemedicine without a prior in-person visit under certain conditions, as well as another final rule that allows Veterans Affairs practitioners to prescribe absent an in-person visit under certain circumstances. 

    To review all of the updates CMS made to its Mental Health Coverage and Substance Use Screenings and Treatment booklets, we recommend reading each document in full. Updates are marked in red for easy reference. Keep in mind that many of these provisions—particularly the listed dates for the mental health in-person requirement to go into effect—may change if Congress passes legislation to extend telehealth flexibilities beyond September 30, 2025 or permanently eliminates the in-person visit requirement altogether.  Stay tuned to CCHP newsletters for future updates.


    Congress Weighs Digital Health Innovation in House Committee Hearing
    In a recent hearing held in late June, the House Ways and Means Health Subcommittee explored the benefits of consumer-facing digital health tools—including wearables, remote monitoring devices, and health apps—to improve chronic disease management, reduce costs, and shift care toward prevention. Witnesses from WHOOP, Winchester Metals Inc., CoachCare, Epic Systems and the Center on Health Insurance Reforms at Georgetown University testified about the need for supportive federal policies around reimbursement, privacy protections, and technology innovation. Lawmakers from both parties expressed enthusiasm for digital health, though some raised concerns about equitable access and privacy safeguards.  Several legislative proposals were discussed, including the Rural Patient Monitoring Access Act and Access to Prescription Digital Therapeutics Act, both aimed at expanding Medicare coverage for digital care. There was also bipartisan interest in improving data privacy and interoperability, though disagreements remained over how far the Health Insurance Portability and Accountability Act (HIPAA) should extend. The hearing highlighted the tension between the promise of digital innovation and the reality of budget-driven coverage cuts.  To view the full hearing, or read each of the witnesses’ testimony, see the House Ways and Means’s website for the full recording and transcripts.

    Telehealth and Nutrition Policy Align Under MAHA Momentum

    A Fierce Healthcare article highlights the American Telemedicine Association (ATA)’s newly launched Virtual Foodcare Coalition—which includes Teladoc, Hims & Hers, and others—which aims to change federal and state policies to support virtually delivered nutrition counseling, food benefits management, and lifestyle coaching. The effort is buoyed by the federal “Make America Healthy Again” (MAHA) campaign, which emphasizes chronic disease prevention through food-based interventions over pharmaceuticals.  The coalition is backing the Medical Nutrition Therapy Act, originally introduced in 2023 and expected to be reintroduced in the current congressional session.  The bill would broaden Medicare coverage for medical nutrition therapy (MNT) to include conditions like obesity, high blood pressure, cancer, and cardiovascular disease, while also expanding provider referral options and supporting demonstration projects via CMS's Center for Medicare and Medicaid Innovation (CMMI).

    The group is also advocating for: With bipartisan interest and alignment with MAHA’s focus on nutrition and prevention, telehealth advocates see this as a pivotal opportunity to embed virtual nutrition care into U.S. health policy.  For more information on the push to expand access to MNT via telehealth, see the full Fierce Healthcare article.

    Latest Developments in CCHP’s Telehealth Policy Finder

    CCHP’s Telehealth Policy Finder look-up tool and Policy Trend Maps were updated throughout the past month based on the latest information from our ongoing state telehealth policy tracking. The latest states to be updated include Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Hawaii, Idaho Illinois, Louisiana, Maine, Montana, New Mexico, North Dakota, Ohio, Oklahoma, Rhode Island, and Wyoming.

    Multiple states have recently made changes to their telehealth policies in an array of policy areas, including their Medicaid programs, private payer laws, professional regulations, and cross-state licensing.  Highlighted changes from this group of states include:
    • ALABAMA: The Alabama Medicaid Agency has updated its Remote Patient Monitoring (RPM) Manual to clarify the validity period for provider orders. Initial and annual RPM provider orders are now valid for one calendar year, and new orders must be obtained at least annually, but no later than 30 calendar days from the date of the previous order. Additionally, beginning July 1, 2025 according to a Medicaid Provider Alert, the Alabama Medicaid Provider Directory will include an indicator showing whether a provider offers telehealth-covered services, helping patients more easily identify virtual care options.  
    • ALASKA: Alaska Medicaid has released a new telehealth fee schedule, now available on its Fee Schedule page. Effective for dates of service on or after January 1, 2025, CPT codes 99441–99443 (audio-only E/M services) have been discontinued. Providers must now use problem-focused exam codes (99202–99205 and 99212–99215) for all modes of telehealth. All required components of these codes must be met to bill appropriately. These changes are effective for billing beginning May 5, 2025. In addition, Alaska updated its statute pertaining to out-of-state provider policy, allowing an exception for ongoing treatment or follow-up care provided by an out-of-state physician or a member of their multidisciplinary care team when addressing a suspected or diagnosed life-threatening condition.
    • ARKANSAS: New legislation (SB 213) enacted in Arkansas requires the Medicaid program to reimburse for remote ultrasound procedures when medically necessary and conducted using secure, FDA-approved digital technology. These procedures must collect and transmit health data electronically from a patient at home or another off-site location to a provider for interpretation and follow-up, and must meet the same standard of care as in-person services. This policy applies to both fee-for-service Medicaid and managed care plans.  The same legislation also mandates coverage of self-measured blood pressure monitoring (SMBP) services for pregnant and postpartum women. Covered services include validated blood pressure devices and replacement cuffs, patient education and training on device use and calibration, and the collection and transmission of readings for care management. Arkansas also updated its veterinary telemedicine regulations. The regulations specify that only licensed veterinarians may provide telemedicine to animal patients located in the state. In emergencies, veterinarians may initiate care via telemedicine without a pre-established relationship but must formalize a veterinarian-client-patient relationship within 7 days for small animals or 21 days for large animals. Finally, Arkansas has joined several interstate compacts, including the Interstate Medical Licensure Compact (IMLC), Psychology Interjurisdictional Compact (PSYPACT), Emergency Medical Services Compact (REPLICA), and Social Work Licensure Compact.
    • COLORADO: A new Colorado rule expands the definition of “Treating Practitioner” under Medicaid to include not only primary care providers but also specialists participating in the Accountable Care Collaborative. Eligible treating practitioners may now include medical doctors (MDs), doctors of osteopathy (DOs), nurse practitioners (NPs), and physician assistants (PAs) with training or qualifications in specialty fields other than primary care, provided they are involved in the member’s care. Additionally, Colorado passed Senate Bill 194, establishing a formal definition for teledentistry. The law defines teledentistry as the use of telehealth technologies—such as electronic communications, remote monitoring, and store-and-forward methods—to deliver oral health services. These services may include assessment, diagnosis, consultation, education, and treatment planning for patients located at an originating site without a dental practitioner, while the licensed dental provider delivers services from a distant site. The technologies must comply with HIPAA requirements. 
    • HAWAII:  Passed HB 951 allowing a healthcare provider to prescribe a three-day supply of opiates via telehealth to a patient who has already been seen in-person by another health care provider in the same medical group. The Hawaiian legislature hopes these changes to prescribing policy will help address barriers to short-term opiate protections while avoiding issues around overprescribing and misuse.
    • MONTANA: Montana Healthcare Programs has issued a provider notice related to continuous glucose monitors. Due to a noticeable increase in denied claims, providers are reminded of proper billing procedures for continuous glucose monitor (CGM) supply allowances. Codes A4238 (adjunctive) and A4239 (non-adjunctive) for non-implanted CGMs may only be billed once per month as a single unit of service, inclusive of all necessary supplies and accessories. Providers are encouraged to consult the CMS Policy Article A52464 for detailed guidance.  Montana Medicaid also released a provider notice discontinuing the use of audio-only E/M codes 99441–99443, which were implemented during the Public Health Emergency (PHE). These have been replaced by codes 98000–98015, which may be billed with the appropriate revenue code depending on provider type. Alternatively, providers may bill a standard E/M code with the appropriate modifier and revenue code.  Montana also passed HB 60, which prohibits insurers from applying higher deductibles, coinsurance, copayments, or other limitations to telehealth services than those applied to in-person care. Finally, Montana has joined several licensure compacts, including those for Dietitians Compact, Physician Assistants (PA), and the Psychology Interjurisdictional Compact (PSYPACT).
    • NEW MEXICO: New Mexico has updated its Behavioral Health Policy and Billing Manual to include expanded guidance and coverage details for several behavioral health services. These now include Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), Functional Family Therapy (FFT), Inpatient Psychiatric Care in freestanding psychiatric hospitals and acute care hospital units, Medication for Opioid Use Disorder (MOUD), Multi-Systemic Therapy (MST), Opioid Treatment Programs (OTPs), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).  In addition, the state enacted Senate Bill 252 encouraging health insurers, HMOs, MCOs, and third-party payors to offer telehealth coverage within their plans, and similarly encourages the state’s Medicaid program to include telehealth services. The legislation clarifies that the New Mexico Telehealth Act does not alter provider scope of practice or permit care delivery methods that are otherwise unauthorized by law. The definition of “health care provider” under the Act was also expanded to include certified peer support workers and any other provider with a Medicaid identification number issued by the state’s health care authority.
    • NORTH DAKOTA: North Dakota updated its Telehealth Policies Document which now makes reference to the state’s redesigned procedure code lookup tool. The tool now clearly indicates which codes are allowable for telehealth and audio-only delivery, replacing the state’s previously maintained list of approved telehealth services, which has since been retired.  Additionally, the state enacted updates to its veterinary and optometry practice laws, introducing new provisions governing the use of telehealth within each profession.
    • OHIO: The Ohio Department of Medicaid (ODM) has released an updated version of the Managed Care Entities (MCE) Telehealth Manual, introducing several clarifications and additions relevant to telehealth billing and delivery. The updated manual now includes a revised telehealth code list and permits audio-only interactions when such services are allowable under Medicare guidelines. It also clarifies billing responsibilities for practitioners operating under contractual arrangements explaining that if the practitioner site does not bill directly, the patient site or contracting practice may instead submit the claim for services delivered via telehealth.  In addition, the manual emphasizes that the Place of Service (POS) code on professional claims must reflect the physical location of the practitioner.
    • OKLAHOMA:  Oklahoma joined the Dietitians Compact and the Social Work Licensure Compact.
    Given the nuanced and varied approaches states are taking with their telehealth policies, please reference CCHP’s telehealth Policy Finder to link to additional details and access each states’ policies in their entirety.

    New Study to Evaluate Telerehabilitation for Chronic Low Back Pain in Rural Areas

    A new trial protocol published in BMJ Open and available on PubMed outlines a forthcoming study that seeks to address a persistent challenge faced by rural communities: limited access to effective treatment for chronic low back pain (LBP).  The ARBOR-Telehealth study—short for Access to Rehabilitation for Back pain in Outlying Rural areas—is a prospective, individually randomized trial designed to assess whether delivering physical therapy via telehealth can improve functional outcomes and reduce opioid use among rural populations.  Chronic LBP is one of the most common and costly musculoskeletal conditions in the United States, yet access to physical therapy—a cost-effective and guideline-recommended treatment—remains limited. National data show that only 7–13% of individuals with LBP ever receive physical therapy, with rural residents facing greater barriers due to transportation issues, workforce shortages, and difficulty taking time off work. These disparities have contributed to higher levels of LBP-related disability and opioid prescribing in rural communities.

    The ARBOR-Telehealth study, led by researchers at Johns Hopkins and taking place in primary care clinics on Maryland’s Eastern Shore, will enroll 434 adults with chronic LBP. Participants will be randomly assigned to one of two groups:
    • Standardized Education Group: Participants will receive evidence-based educational materials on managing back pain via a study website, similar to what a primary care provider might offer in routine care.
    • Risk-Informed Telerehabilitation Group: Participants will receive individualized physical therapy remotely via a video-enabled telehealth platform. Physical therapists will tailor sessions based on patients' clinical risk profiles.
    The trial will examine a range of outcomes, including LBP-related disability (primary outcome), as well as pain intensity, opioid use, quality of life, and use of healthcare services (secondary outcomes). Researchers will also assess implementation metrics such as acceptability, feasibility, and adoption using the RE-AIM framework. This research may offer critical insights for scaling physical therapy access in underserved areas and for addressing the over-reliance on opioids to manage chronic musculoskeletal pain. It is one of the first trials of its kind to study a risk-informed telerehabilitation model in a real-world rural setting.  For more details, see the full study protocol published on PubMed.

    Remote Care Quality & RPM’s Future

    As remote patient monitoring (RPM) programs continue to expand, new evidence from Michigan Medicine featured in a TechTarget article, underscores the importance of evaluating RPM’s clinical effectiveness, implementation strategies, and the value to patients, providers, and payers.

    Michigan Medicine launched its Patient Monitoring at Home program in April 2020 to care for patients recovering from hospitalization, managing chronic conditions, or undergoing post-rehabilitation treatment. The program provides patients with a kit containing Bluetooth-connected devices—such as a tablet, blood pressure cuff, and thermometer—so care teams can track vital signs daily and intervene if concerning trends emerge.  Now, five years later, researchers at Michigan Medicine have published a study assessing the program’s impact. Analyzing data from 1,139 patient encounters between November 2020 and August 2022, the study found:
    • A 59% average reduction in hospitalizations in the six months after RPM enrollment.
    • The greatest benefits were seen in patients monitored for 60 days or fewer. Longer durations were less effective, likely due to the complexity of those patients' medical and social needs.
    The findings reinforce that RPM can be an effective tool to reduce unnecessary hospital visits, particularly for conditions like heart failure and hypertension. However, program leaders interviewed for the article emphasized that data alone isn’t enough—successful RPM implementation also requires clinical oversight, infrastructure, and strategic alignment.  Medical Director Dr. Ghazwan Toma noted that evidence is critical not only to optimize patient care, but also to support provider trust, justify health system investment, and guide payer reimbursement decisions. Given the variation in how RPM is delivered—from simple app-based check-ins to comprehensive, device-supported models—clear evidence can help distinguish which services deliver meaningful value and for whom.  For more details on the study, see the abstract and full text [full access requires purchase], as well as coverage of the study in the TechTarget article.

    What’s New at CCHP this Month?

    CCHP is continually working to create helpful informational content to keep those interested in telehealth and related policies up to date via our policy finder, informational factsheets, webinars, reports and email blasts.  As you may already be aware, CCHP regularly distributes a single topic specific email every Tuesday titled “Telehealth Tuesdays”.  If you are not yet on our distribution list to receive these emails, and would like to be added, you can do so by registering on the CCHP website.







    Over the past month, we have curated and featured a series of insightful topics in our Telehealth Tuesday email blasts.  They include:

    JULY 1, 2025:  It’s Not Just About Medicare Policy, Private Payer Policy Is Important Too! covering several recently passed state laws that are set to directly impact private payer telehealth coverage. Maryland (HB 869/SB 372) and Mississippi (SB 2415) extended key provisions that were close to expiring, echoing the uncertainty currently seen in federal Medicare telehealth policy. Meanwhile, Texas HB 1052 introduced a notable change: private health plans must now reimburse telehealth services delivered across state lines when the patient or provider is located outside of Texas at the time of care the same as it would have if the patient and provider where in the state at the time of the telehealth service, if certain conditions are met.

    JUNE 24, 2025:  Shaping the Future of Biomedical AI: NIH Seeks Input on New Strategy with Implications for Telehealth covering the National Institutes of Health (NIH) development of a comprehensive strategy to guide the use and advancement of artificial intelligence (AI) in biomedical research and healthcare. Through its recently released Request for Information (RFI): Inviting Comments on the NIH Artificial Intelligence (AI) Strategy, the NIH seeks input from researchers, health systems, developers, and other stakeholders to help shape the future of biomedical AI. The strategy may influence areas like AI-powered diagnostics, remote monitoring, and telehealth delivery. Comments are due by July 15, 2025.

    JUNE 17, 2025:  Organizational Factors that Affect Telehealth Utilization in an FQHC/RHC Setting covering the Rural Telehealth Research Center (RTRC) release of a new research brief, Organizational Factors Associated with Using Telehealth Services, based on interviews with leaders from 17 rural health clinics (RHCs) and federally qualified health centers (FQHCs) across six states. Conducted between May and September 2024, the study highlights the challenges, trends, and resource needs these clinics face in delivering telehealth services.

    Check the original resource at : https://www.cchpca.org/resources/category/newsletter/

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