Since the Trump administration took the reins for a second term in January, questions about what may be next for providers of substance use disorder (SUD) care have swirled.

Between Medicaid cuts and new stipulations for work requirements on top of changes to key agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA), which has been responsible for block grants, the first half of 2025 has left many providers in a state of reaction.

Despite rapid shifts in policy and expectations creating uncertainty, telehealth regulations hold promise to make care access and treatment a bit easier across the field, that is, in most states.

One key change, set to take effect December 31, 2025, will allow telehealth providers to prescribe buprenorphine for opioid use disorder for up to six months without an in-person initial visit. After that timeframe, future prescriptions would require an in-person medical evaluation.

Lowering the barrier in this way for OUD treatment could be game-changing for patients and providers. Still, state differences may create some headaches, experts explained during Behavioral Health Business’ Addiction Treatment Forum this July.

“If you’re still hamstrung with needing to provide that face-to-face treatment first, then the telehealth is almost rendered less useful than it could be, because you’re still having to get a provider in front of that patient first,” Dr. Lea McMahon, CEO of Symetria Recovery said. “We’re seeing places where that is being eliminated, but when we look at state regulations, we’re seeing spaces where that regulation is still being upheld for certain medications and then the access is restricted again.”

Symetria Recovery is an outpatient addiction treatment provider that specializes in OUD treatment. The company is based in Naperville, Illinois and has multiple locations throughout the state as well as in Texas.

While in some ways, federal regulations are beginning to relax around opioid treatment providers (OTPs) and modernizing methadone and other prescribing rules, McMahon noted that the contradictions between state rules can sometimes “create major disruption in staffing patterns and access to care.”

Under the new Department of Health and Human Services rule, there is also a proposal to extend the telehealth prescribing capabilities of some providers beyond that six-month window and do so continuously under a special registration; however, that element has not yet been finalized.

It’s an area that Dan Schwartz, director of quality and addiction services at the National Association for Behavioral Healthcare (NABH), and his team are watching closely.

“The broader proposed special registration for telemedicine would allow any practitioner who obtains the special registration to prescribe controlled substances via telemedicine to their patients indefinitely, without ever conducting an in-person medical evaluation,” Schwartz explained. “If that is finalized, then buprenorphine providers could, as soon as next year, prescribe for up to six months just remotely with the rule that was finalized earlier this year, and then after that, if they have a special registration, they could continue to do it under their special registration. We’re hoping that the DEA makes significant modifications to that, because there are a lot of burdens associated with that rule related to patient identity verification and specific record-keeping requirements.”

Lawmakers also introduced similar legislation in June with the Telemental Health Care Access Act, which would remove the requirement for Medicare beneficiaries to be seen in person within the first six months of starting behavioral health services with a provider.

“People are accepting telehealth as a legit way to deliver healthcare and to deliver therapy. My hope is that we continue that,” Pete Nielsen, president and CEO of the National Behavioral Health Association of Providers (NBHAP), said. “Not everybody fits into a box and you’re able to then deliver health care, counseling and therapy to a wider array of people in different scenarios.”

Both policies could be instrumental in providing more services to rural communities, in particular, these experts explained, but discrepancies between rural vs. urban areas as well as state to state, sometimes create additional barriers. 

“Telehealth policy changes have been very instrumental in improving access to care, but only when the states actually support that regulation,” McMahon said.

And what is effective in one state or area may not be applicable in another, Nielsen added.

“The problem that we have is that bigger cities tend to set policy and tend to set regulations based upon what is happening in those bigger cities,” Nielsen said. “That affects rural communities. For example, we’ve seen an uptick in wanting to put distance requirements in facilities, and that’s been an issue because it affects the rural community, because they need to be clustered together.”

Staying up to date in changes with telehealth will be imperative for the year ahead as these companies navigate other policy changes and look for ways to remove barriers while maintaining the quality of care.

Heading into 2026, McMahon noted that providers, particularly in smaller organizations, should “make sure that provider time is being maximized, that schedules are being maximized, and reduce as much administrative burden on those individuals as possible.”