The Drug Enforcement Administration (DEA) will extend its telehealth flexibilities past the end of the year.

Health care providers that have linked telehealth and controlled substance prescribing have been staring down a regulatory cliff following inaction by Congress on the issue. Twice already, the DEA has extended COVID-era regulation that provided wide flexibility when it comes to the use of telehealth.

Those flexibilities will end Dec. 31, 2024. The resumption of these rules would, among other things, require patients to first be seen in person before they can be treated via telehealth and receive controlled substances.

On Oct. 10, the DEA submitted a final rule to the White House’s Office of Management and Budget (OMB), which oversees the coordination and review of executive branch action. It’s often a final step before rules are made public.

The rule itself is not available to the public. BHB has requested additional information from the DEA but has not yet received a response. This story may be updated.

For well over a year, the DEA has muddled through the rulemaking process to establish a new post-COVID telehealth regulator paradigm. Such a paradigm shift is required to match up with the new reality of telehealth being central to behavioral health in a way that it is not in other segments of health care. Health claims data show that behavioral health-related claims make up more than two-thirds of all telehealth claims.

Last month, other media outlets reported that the DEA was apparently working on a proposed rule that could be considered a moderation from its previously released rule. However, advocates in the space still see the rule as a detriment to telehealth-focused behavioral health providers.

At the beginning of the month, the American Hospital Association (AHA) called for a two-year extension.

“Crucially, this will prevent harmful interruptions in the delivery of necessary patient care dependent on continued virtual prescribing of controlled substances without a prior in-person evaluation, as well as ensure adequate time for rulemaking to establish a permanent pathway,” the AHA said in letters it sent to the U.S. Department of Health & Human Services (HHS) and the DEA.

Congress passed a law requiring the DEA to develop a special registration process that would allow approved health care providers to prescribe certain controlled substances without an in-person vision twice in the last 20 years; each time, the DEA has simply not produced that process.

Such a mandate was issued via legislation in 2008 as part of the Ryan Haight Act — the law that largely governs telehealth and prescribing — and again in the SUPPORT for Patients and Communities Act (SUPPORT Act) of 2018. However, some addiction treatment advocates think that pushing for the establishment of a special registration is “misguided.”

In March 2023, the DEA released two interrelated rules — one governed most Schedule II controlled substances while the other specifically applied to addiction treatment-focused medication. They were effectively shouted down by advocates. Since then, the DEA has extended its temporary telehealth flexibilities pending finalization of new rules.