BY Bradley S. Byars, Esq. and Michael R. Alexander, Esq., Brown & Fortunato, P.C.
Consider, for a moment, how dramatically our healthcare landscape has transformed in the last five years. What began as an emergency response to a global pandemic has evolved into something far more permanent: a fundamental reimagining of how we deliver medical care. Most recently, on December 21, 2024, Congress took another step in this evolution, passing legislation that extends Medicare telehealth flexibilities through March 31, 2025. This latest extension, while temporary, signals a broader shift in how we think about healthcare delivery in the modern age.
The story of telehealth’s transformation begins with the end of the federal COVID-19 Public Health Emergency (PHE) on May 11, 2023. Rather than allowing pandemic-era flexibilities to lapse, Congress acted through the Consolidated Appropriations Act and subsequent legislation to preserve crucial accommodations. The result? A framework that fundamentally expands access to care: Medicare beneficiaries in any location—not just rural areas—may now receive telehealth services; patients can receive care from the comfort of their homes; and critically, Federally Qualified Health Centers and Rural Health Clinics can serve as distant site providers, extending their reach into historically underserved communities.
Perhaps nowhere has this evolution been more striking than in the realm of controlled substance prescribing. The Ryan Haight Act traditionally demanded in-person medical evaluations, but recent Drug Enforcement Administration guidance now permits remote prescribing through December 31, 2025. For Texas providers treating chronic pain, opioid use disorder, or mental health conditions, this means continued ability to prescribe remotely—provided they adhere to DEA guidelines, Texas Medical Board rules, and state monitoring requirements.
In Texas, the legal framework for telehealth practice has evolved in parallel with federal changes. The Texas Medical Board’s (“TMB”) telemedicine rules establish clear guidelines while emphasizing a fundamental principle: virtual care must meet the same exacting standards as in-person treatment. While the rules generally favor video-based interactions, they recognize practical realities, permitting audio-only encounters for certain mental health services when circumstances warrant.
Rural communities have emerged as particular beneficiaries of these changes. Rural Health Clinics and Federally Qualified Health Centers now serve as “distant sites,” billing Medicare directly for virtual encounters through March 2025. This shift has profound implications for access to care, especially in Texas’s vast rural expanses, though providers must carefully navigate both federal requirements and state-specific guidelines.
Not all pandemic-era flexibilities have survived, however. Medicare’s temporary allowance for virtual “direct supervision” ended on December 31, 2023, requiring a return to physical oversight. Similarly, practitioners can no longer provide telehealth from undisclosed locations, and certain services have returned to lower facility-based reimbursement rates.
As we look ahead, new challenges emerge. HIPAA enforcement has returned in full force, demanding secure platforms and proper business associate agreements. Documentation requirements remain exacting: providers must record not just clinical findings but also the technical parameters of each virtual encounter. Cross-state care delivery presents its own complexities, as Texas maintains strict oversight of out-of-state practitioners.
The expansion of telehealth has proved particularly valuable in behavioral health, where audio-only options have bridged the digital divide for patients lacking broadband access. Mental health practitioners operating under Texas licenses may now reach patients through various virtual modalities, though they must carefully adhere to both their licensing boards’ standards and TMB guidelines. The extension of controlled substance prescribing flexibilities has revolutionized medication-assisted treatment, even as providers remain alert to potential regulatory changes.
Looking forward, stakeholders anticipate more permanent reforms to Medicare’s telehealth coverage. Texas legislators have consistently championed telehealth expansion, particularly through measures ensuring payment parity. This support reflects a broader recognition: telehealth has moved beyond its origins as an emergency measure to become an essential tool in modern medical practice. Success in this new landscape will require careful attention to regulatory requirements, certainly, but also an appreciation for telehealth’s potential to transform healthcare delivery. As federal and state policies continue to evolve, one thing remains clear: virtual care will endure as a vital component of Texas’s healthcare infrastructure, expanding access while maintaining the highest standards of medical practice.