Telehealth’s growing role: Policy shifts, licensing compacts, and compliance issues

The rapid growth of telehealth has significantly reshaped healthcare delivery, improving accessibility and convenience for patients. However, telemedicine regulations remain complex, with federal and state-level legislative actions shaping the landscape. While temporary flexibilities have extended access to virtual care, digital health regulations continue to evolve, creating uncertainty for healthcare providers and technology companies.

As governments worldwide refine telemedicine and global regulations, healthcare stakeholders must navigate shifting policies, reimbursement models, and licensing requirements.

Federal extensions of telehealth flexibilities

On March 15, 2025, President Trump signed a Continuing Resolution (CR) that extends Medicare telehealth flexibilities until September 30, 2025. Originally introduced during the COVID-19 pandemic, these provisions ensure continued access to virtual care.

Under this extension, Medicare beneficiaries can receive telehealth services from any location, including their homes. Additionally, the in-person visit requirement for tele-mental health services remains delayed, allowing patients to continue accessing remote mental health care without needing to see a provider in person.

All Medicare-eligible providers can still deliver telehealth services, ensuring broad access to virtual care. Furthermore, audio-only telehealth services remain reimbursable, preserving access for individuals without reliable internet or video capabilities.

Additionally, the Acute Hospital Care at Home Program remains active, enabling hospitals to provide inpatient-level care remotely. Despite these extensions, long-term uncertainty remains, prompting calls for permanent policy solutions.

Congressional efforts for permanent reforms

While the CR provides temporary relief, multiple bills aim to make digital health and global regulations more stable.

Telehealth Modernization Act of 2024 (H.R. 7623): Proposes permanent extension of key telehealth flexibilities.

CONNECT for Health Act of 2023 (H.R. 4189; S. 2016): Seeks to remove geographic restrictions and expand home-based telehealth services.

Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261): Extends key telehealth provisions, including hospital-at-home programs, through 2026.

While these bills represent progress, the absence of unified federal policies complicates investment and long-term strategic planning for healthcare organizations.

State telehealth regulations and licensing

While federal policies shape the overall landscape of telehealth, state-level regulations play a crucial role in defining how virtual care is delivered and reimbursed. States continue to introduce new laws that expand telehealth access, set professional standards, and address licensing challenges. These evolving telemedicine regulations impact healthcare providers, pharmacists, and digital health companies, influencing the accessibility and quality of remote care.

Expanding telehealth practice standards

States continue to refine telemedicine regulations by introducing new practice standards and reimbursement policies.

In North Dakota, proposed amendments aim to clarify tele-optometry regulations, outlining how optometrists can establish provider-patient relationships virtually. Indiana introduced a bill that would allow telehealth prescriptions for certain opioid treatments, improving access to medication-assisted therapy. Meanwhile, Ohio enacted legislation supporting remote dispensing pharmacies, enabling pharmacists to provide virtual consultations.

Texas has mandated reimbursements for teledentistry, making virtual oral evaluations more accessible. Arkansas also expanded telehealth by passing laws that support veterinary telemedicine and maternal tele-ultrasound services. These developments underscore the growing influence of digital health regulations in integrating telehealth into specialized medical fields.

Licensure compacts and cross-state practice

Interstate licensing restrictions remain a major barrier to telehealth expansion. Several states have addressed this issue through licensure compacts, allowing professionals to practice across state lines under a single license.

Recent developments in telehealth licensing compacts include efforts across multiple states to expand cross-state practice. Mississippi, Kansas, and North Dakota have introduced a dietitian licensure compact, while Mississippi, Maryland, and North Dakota have advanced a social work licensure compact.

In addition, North Dakota and New Mexico have proposed an occupational therapy licensure compact, and New Mexico has introduced an audiology and speech-language pathology compact. These initiatives aim to improve access to qualified professionals and streamline licensing processes for telehealth providers.

By expanding these agreements, states aim to reduce administrative burdens and improve access to qualified practitioners, particularly in rural areas. However, inconsistencies between state and federal laws continue to complicate cross-state telehealth practices.

Key compliance challenges in telehealth

Medicare billing and reimbursement: Despite ongoing telehealth flexibilities, Medicare billing requirements remain strict. Providers must ensure that virtual services meet medical necessity standards, follow documentation and coding guidelines, and comply with state-specific laws governing telehealth services.

The lack of universal reimbursement models among insurers adds another layer of complexity. Some states and private payers reimburse telehealth visits at lower rates than in-person care, creating financial challenges for providers.

Telehealth and controlled substances: Teleprescribing controlled substances remains a key issue in telemedicine and global regulations. The DEA and HHS are still debating long-term policies for virtual opioid prescriptions, despite temporary waivers. Concerns include preventing misuse, setting guidelines for mental health and pain management, and balancing access with oversight. Without clear rules, patients and providers face ongoing uncertainty.

Digital health privacy and security risks: As telehealth adoption grows, data privacy and cybersecurity risks increase. Key challenges include reliance on third-party telehealth platforms, raising concerns over data security, potential HIPAA violations if platforms lack encryption or security measures, and unclear data-sharing policies between telehealth providers, insurers, and technology companies.

With rising concerns over patient privacy, global regulations on digital health must evolve to ensure robust security measures while allowing innovation in virtual care delivery.

The future of telehealth policy

Despite temporary extensions, the absence of permanent telehealth policies creates uncertainty for healthcare providers and investors. Industry experts are advocating for lasting Medicare telehealth flexibilities to ensure financial stability for providers.

Potential challenges and considerations

As the September 30, 2025, deadline approaches, lawmakers must address key challenges shaping the future of telehealth. One major concern is balancing virtual and in-person care, as some medical conditions still require physical examinations despite the convenience of telemedicine.

Another issue is ensuring equitable access, particularly in rural areas where limited broadband infrastructure continues to hinder telehealth adoption. Additionally, reimbursement gaps remain a hurdle, with many insurers hesitant to cover virtual care at the same rate as in-person visits.

The future of telehealth depends on comprehensive and permanent regulatory solutions. While temporary extensions have kept telehealth accessible, long-term uncertainty threatens its continued growth. Addressing digital health and global regulations, expanding licensure compacts, and strengthening cybersecurity will be critical for ensuring telehealth’s long-term success.

As technology and healthcare continue to evolve, policymakers, providers, and insurers must collaborate to develop a sustainable telehealth model that prioritizes accessibility, compliance, and patient safety.