Telehealth After COVID-19: Permanent Policy Changes and What Remained

The pandemic didn't create telehealth — it detonated it. Between March 2020 and the end of that year, Medicare telehealth visits increased from roughly 840,000 per year to more than 52 million, according to the HHS Office of Inspector General. What followed was a five-year negotiation between urgency and permanence — some emergency rules quietly became law, others expired on a schedule, and a few are still suspended mid-air. This page maps what changed, what stuck, and where the lines are still being drawn.

Definition and scope

"Post-pandemic telehealth policy" refers to the regulatory landscape that emerged after the Public Health Emergency (PHE) declared under Section 319 of the Public Health Service Act expired on May 11, 2023. During the PHE, the Centers for Medicare & Medicaid Services (CMS) waived or modified more than 60 telehealth requirements. When the PHE ended, Congress had already acted to extend a subset of those waivers — specifically through the Consolidated Appropriations Act of 2023, which pushed many Medicare telehealth flexibilities through December 31, 2024. The Consolidated Appropriations Act of 2024 then extended most of those provisions again through September 30, 2025.

The scope here is deliberately federal-first. States layered their own emergency orders on top of the federal structure, and those have unwound on different timelines. Telehealth state laws and licensure vary enough to warrant separate treatment — what follows focuses on the Medicare and federal regulatory framework.

How it works

The mechanics of post-PHE telehealth policy operate on three distinct tracks.

1. Provisions made permanent by Congress

A handful of changes crossed the line from temporary to permanent before or shortly after the PHE ended:

  1. Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as distant sites for telehealth services permanently — a change codified in the Consolidated Appropriations Act of 2021.
  2. Mental health services delivered via telehealth no longer require a prior in-person visit, provided an in-person visit occurs within 12 months of initiation and annually thereafter (42 U.S.C. § 1395m(m)(7)).
  3. Audio-only services for behavioral health became permanently reimbursable for patients who cannot access video technology — a recognition that the telehealth digital divide is a clinical reality, not just an equity abstraction.

2. Extended but not permanent waivers

These remain in place through current congressional extensions but could lapse without further action:

3. Provisions that expired

The blanket waiver allowing any provider to deliver telehealth anywhere without credential verification at the originating site ended with the PHE. Telehealth credentialing and privileging requirements reactivated, meaning providers must again comply with The Joint Commission and CMS Conditions of Participation for hospital-based services.

Common scenarios

Three situations illustrate how the post-PHE policy landscape plays out in practice.

A Medicare beneficiary in Chicago seeking talk therapy. Pre-2020, this patient would not have qualified for Medicare telehealth because urban addresses were excluded. Under the current extended waiver — and the permanent behavioral health carve-out — the visit is covered, can happen via video from the patient's living room, and requires no prior in-person session for the first year. The mental health telehealth coverage rules now reflect a fundamentally different baseline than the pre-pandemic norm.

A rural patient managing Type 2 diabetes via remote monitoring. Remote patient monitoring codes (CPT 99453, 99454, 99457, 99458) were clarified and expanded during the PHE and have not been rolled back. A provider supplying a continuous glucose monitor with remote data review and monthly check-ins can bill these codes under Medicare — as long as documentation meets the 16-day minimum data collection threshold per 30-day period.

A psychiatrist prescribing a Schedule IV medication via video. This scenario sits in the extended-but-not-permanent category. The DEA's proposed special telemedicine registration rule, published in 2023, would create a registry pathway for prescribers to continue controlled substance prescriptions initiated via telemedicine. Until that rule is finalized, a temporary exception applies to patients with existing prescriptions, but new initiations carry more friction. See telehealth prescribing rules for the current DEA framework.

Decision boundaries

The sharpest distinction in post-PHE telehealth policy is the line between permanent structural changes and time-limited congressional extensions. Conflating them is the most common error in both provider planning and patient expectation-setting.

Permanent changes are embedded in statute and do not require annual reauthorization — the FQHC distant-site rule and the behavioral health in-person follow-up requirement fall here. Extended waivers, by contrast, exist on a cliff edge: each budget cycle is a potential rollback. The telehealth policy and regulation landscape tracks those cliffs in real time.

A second boundary involves payer type. Medicare's flexibility is not automatically mirrored by Medicaid or commercial insurers. Medicaid telehealth coverage is set state-by-state, and private insurance telehealth coverage varies by plan, state mandate, and benefit year. A service that Medicare covers via audio-only may require video for a commercial plan in the same state.

The National Telehealth Authority tracks the regulatory status of both permanent and extended provisions as legislative cycles move. For the full statistical picture of how utilization patterns shifted through and after the PHE, telehealth statistics and utilization data provides sourced figures across payer categories.

References