Following the COVID-19 public health emergency, the federal Centers for Medicare and Medicaid Services (CMS) made permanent expansions to the coverage of telehealth under the Medicare program. CMS has greatly increased the number of services included on the permanent list of telehealth services and expanded the list of practitioners authorized to provide mental health telehealth to include physicians, nurse practitioners, LCSWs, clinical psychologists, marriage and family therapists and mental health counselors. These changes directly reflect the impact that the widespread availability of telehealth technology has had on the delivery of health care, particularly since the public health emergency. Considering widespread reports that the United States is amid a mental health crisis,1 increased access to telehealth is a key component in ensuring that individuals receive necessary and life-saving mental health care and treatment. The following is a summary of Federal and state efforts in furtherance of this goal.
Medicare
The Medicare program will now permanently cover telehealth for mental health and substance use disorder (MH/SUD) services provided to patients at home. In other words, there are no longer any geographic restrictions on originating sites (patient location) for MH/SUD care. CMS has also expanded its definition of home, which now includes a patient’s residence, homeless shelters, group homes, hotels and other settings that a patient may identify as home, whether temporary or permanent. In this context, home also includes circumstances where the patient, for private or other personal reasons, chooses to travel a short distance from their home for a telehealth service, perhaps to a car or other private space. In addition, the Medicare program now covers MH/SUD services delivered via audio-only communications (without a synchronous video component), if the patient does not have access to two-way, audio-video technology or does not consent to the use of two-way, audio-video technology.
At the same time, CMS has imposed some limitations on the coverage of telehealth in the mental health context, i.e., the 6-month rule and the 12-month rule. Under the 6-month rule, CMS has mandated that all new Medicare patients be seen at least once in person during the 6 months prior to initiating mental health telehealth services. For practical purposes, this means that the initial visit with a new Medicare patient must be in-person, with any telehealth follow-ups taking place within 6 months of the initial in-person visit. Please note that this rule applies only to new patients. CMS has clarified that if a patient has previously been seen via telehealth, that patient will be deemed an “established” patient and the 6-month rule will not apply. This rule was initially slated to go into effect on October 1, 2025, but implementation was extended to January 30, 2026, due to delays caused by the federal government shutdown.
Additionally, under the 12-month rule, which will also go into effect on January 30, 2026, all established Medicare patients must be seen in person every 12 months. However, to take individual circumstances into account, there are a variety of exceptions built into this rule. Here, an in-person visit will not be required if the benefits of a non-telehealth service are outweighed by the risks and burdens associated with an in-person service, for example:
- An in-person service is likely to cause disruption in service delivery.
- An in-person service has the potential to worsen the patient’s condition.
- If patient is in partial or full remission and only requires maintenance level of care.
- Patients are clinically stable and in-person visit has risk of worsening patient’s condition, creating undue hardship on self or family; or
- Patients are at risk of disengagement with previously effective care.
The basis for any exception must be noted in the patient record. The follow-up in-person visit may be furnished by a different psychiatrist in the same group or practice if the original psychiatrist is unavailable. Please note that the 6-month and 12-month requirements apply solely to mental health treatment and not to substance use disorder (SUD) treatment. Now, there is no Medicare requirement for in-person visits for SUD treatment. Of course, it must be noted that in-person visits may occur more than once a year, with frequency dictated by clinical judgment and medical necessity.
The new framework for telehealth coverage of MH/SUD treatment under the Medicare program is a significant step forward in ensuring access to services for those who face challenges in accessing in-person treatment. In this case, CMS has made a clear distinction between MH/SUD telehealth treatment and non-MH/SUD telehealth treatment. Now, only telehealth for MH/SUD has been identified as a permanent change within the Medicare program.
Another recent change is the ability of providers rendering non-patient facing or telehealth services from a home office to keep their home address private. Providers may now request that their home address be listed in Medicare records solely as a “Home office for administrative/telehealth use only.” This will suppress the street address and phone number in Medicare records. This approach is also helpful for circumstances where there is a safety concern related to a provider’s practice information being made publicly available.
New York Coverage of Telehealth
New York has already implemented a similar framework that is even more robust, mandating across-the-board coverage of all telehealth treatment by commercial plans and carriers, Medicaid Fee-for-Service and Medicaid Managed Care plans. Audio-only telehealth is also covered to the extent the patient is unable or declines to participate in audio/video telehealth. In addition, New York has enacted a law mandating reimbursement parity between in-person care and telehealth “on the same basis, at the same rate, and to the same extent the equivalent services, … are reimbursed when delivered in person.” This reimbursement parity law will be sunset on April 1, 2026. The New York State Psychiatric Association and other stakeholders strongly advocate that these provisions not be permitted to expire and be made permanent as part of the FY 2026-27 state budget.
In addition to statutory changes regarding coverage of telehealth, New York is also looking closely at workforce shortages and its role in inhibiting access to care. The NYS Assembly Standing Committee on Mental Health and Standing Committee on Alcoholism and Drug Abuse recently announced, as of this writing, a public hearing scheduled for December 10, 2025, to examine the status of the behavioral health workforce. As stated, “The purpose of this hearing is to provide the Committees with an opportunity to examine the status of the behavioral health workforce, including attrition and vacancy rates, and its impact on a person’s ability to access behavioral health services.” The hearing notice cites “a lack of access to services, long waiting lists, and an increase in complications associated with unmet treatment needs for individuals at risk of, or diagnosed with, mental health, substance use or other medical conditions.” It is essential that government leaders and legislative bodies gather information about the current workforce crisis and identify possible remedies and next steps that may be reflected in further legislative action.
In conclusion, telehealth has played a critical role in extending the reach of the workforce to enhance access to care for those in need of mental health and substance use disorder services. Surveys have consistently found an increase in Americans willing to use telehealth for mental health care. Telehealth also helps overcome other persistent barriers to care including transportation challenges and the stigma associated with walking into an office. As we consider ways to enhance the workforce, it is important we maintain access to telehealth as part of that plan for the short and long term. Along with the rise of telehealth is the rapid proliferation of artificial intelligence in all spaces, including mental health. As it stands, New York State and other states are taking or contemplating action regarding the use of AI in mental health care. The New York State Senate Committee on Internet and Technology has scheduled a public hearing on January 15, 2026 to solicit testimony on “… risks, solutions, and best practices with respect to the use of artificial intelligence in consequential or high-risk contexts, and related issues, such as classification of the types and risk levels of AI uses, frameworks for auditing AI tools for bias, and transparency improvements.”
The good news is New York State recently ranked #1 for mental health in Mental Health America’s 2025 The State of Mental Health in America based on a set of measures including prevalence and access to care. This acknowledgement truly reflects the collective work of policymakers, regulators, advocates, and patients, while recognizing the challenges that remain to achieve the right care at the right time in the right place.
Rachel A. Fernbach, Esq. is the Executive Director and General Counsel of the New York State Psychiatric Association and a Partner of the firm Moritt Hock & Hamroff, LLP, where she concentrates her practice in the area of not-for-profit law and health care law with a specialty in psychiatry and other mental health services.
Jamie Papapetros is Research and Communications Coordinator at New York State Psychiatric Association’s Government Relations Office, in conjunction with Karin Carreau of Carreau Consulting. Mr. Papapetros has a decade of experience in government relations, identifying, tracking and analyzing pertinent legislation, providing legislative and electoral research, memo preparation and in depth legislative and regulatory reports.
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