As the behavioral health industry faces increasing uncertainty around virtual care rules, facility-based providers may hold a significant advantage over their virtual-only peers. With the ability to offer both in-person and remote services, these operators are better prepared to navigate the evolving landscape of telehealth regulations in behavioral health.
This insight emerged from a recent panel hosted by Behavioral Health Business, where experts discussed how providers can remain resilient in the face of changing DEA rules, patient expectations, and legislative delays.
Why Facility-Based Operators Are Better Equipped
During the COVID-19 pandemic, the behavioral health sector rapidly scaled up its use of telehealth. But with the end of the public health emergency, the question now is: what do long-term telehealth regulations in behavioral health look like?
According to Andy Flanagan, CEO of Iris Telehealth, hybrid providers that offer both in-person and virtual care are more flexible and compliant by default.
“Virtual resources are really best used to fill gaps in access and in care,” Flanagan said. “It’s not a standalone, disconnected process to have a telepsychiatry program or a teletherapy program.”
These hybrid models allow facility-based operators to respond dynamically to regulatory shifts. In contrast, virtual-only providers—many of which thrived under the relaxed rules of the pandemic—are now scrambling to adjust.
The Ryan Haight Act And DEA Delays
At the heart of today’s regulatory limbo is the Ryan Haight Act, which normally requires an in-person medical evaluation before a provider can prescribe controlled substances via telehealth. In March 2020, the Drug Enforcement Administration (DEA) issued a waiver, allowing clinicians to bypass that requirement—a move that fueled the expansion of telehealth MAT (medication-assisted treatment) programs.
However, the DEA has yet to release permanent rules, despite being years behind schedule. This delay has many providers concerned about what’s next for telehealth regulations in behavioral health.
Healthcare attorney Alexis Bortniker, a partner at Foley & Lardner LLP, emphasized that this inaction is creating serious operational uncertainty.
“We want to retain regulatory compliance,” she said. “But we can’t dump our clients if we’ve been serving them for the last years via telehealth because of an in-person requirement.”
She added that providers are now being advised to proactively prepare for change, even though the DEA exemption could potentially be extended independent of the public health emergency.
Virtual-Only Providers May Need To Pivot
If the DEA reinstates the in-person visit requirement, telehealth-only behavioral health companies will face a steep uphill battle. Without physical infrastructure or partnerships with traditional facilities, they may be left without viable ways to serve patients legally and ethically.
“It’s trickier for those companies that started telehealth-only,” Bortniker said. “They’ve never had to think through how that relationship between a facility and the providers would work.”
As telehealth regulations in behavioral health continue to evolve, virtual providers will likely need to develop strategic partnerships or invest in brick-and-mortar solutions to remain competitive.
The Role Of Quality In Shaping Telehealth Policy
Another recurring theme in the discussion was the importance of clinical quality. As policymakers craft new rules, demonstrating exceptional care delivery will be crucial.
“One thing that really needs to remain a priority as we see draft legislation is the focus on the quality of care,” said Caiti Crum, Clinical Director of Therapy at Foresight Mental Health. “We really need to ensure that our providers have the right training and the right standard of care.”
She noted that maintaining high-quality therapeutic relationships in virtual settings is not only possible—it’s necessary to prove that telehealth regulations in behavioral health can support safe, ethical, and effective treatment models.
Bad Actors Threaten Progress
Recent controversies around companies like Cerebral Inc. have also added pressure. Under federal investigation, Cerebral has become a cautionary tale about what happens when telehealth operations expand without strong clinical oversight or adherence to regulations.
“It’s the worst possible moment for Cerebral to generate bad press for telehealth in behavioral health,” Flanagan said. “It’s a hyper-charged political environment and all of us just want to deliver care.”
As telehealth regulations in behavioral health tighten, the industry must collectively protect its reputation by adhering to evidence-based, patient-first practices—and distancing itself from opportunistic business models that exploit regulatory gray areas.
Facility-Based Providers Bring Institutional Strength
Traditional operators may hold the upper hand not just because of infrastructure, but also because of experience. They’ve spent years adapting to changing payment models, complex compliance systems, and evolving care standards. That experience makes them more nimble as new regulations roll in.
“I think traditional brick-and-mortar health care is used to dealing with a lot of things like payment models, and as payment models change, patient interactions with those change,” Bortniker said.
That resilience may be crucial as telehealth regulations in behavioral health continue to shift in the post-pandemic era.
A Renewed Purpose For Clinicians
Despite the uncertainty, many behavioral health professionals feel that telehealth has rekindled their passion and purpose. The ability to reach more patients—especially in underserved areas—has become a vital part of their clinical mission.
“From a clinical perspective, [telehealth] has reinvigorated a deep connection with our reason for being,” Crum said. “That has resulted in a real review and refinement of our ethics, our standards of care, our quality of care from end to end.”
This renewed focus on quality and ethics is exactly what will sustain telehealth long-term—even as telehealth regulations in behavioral health become more defined and, perhaps, more restrictive.
Final Thoughts
The behavioral health industry is at a crossroads. Telehealth is no longer an emergency measure—it’s a permanent fixture of modern care. But to preserve its promise, providers must build resilient, integrated systems that deliver high-quality outcomes across settings.
As lawmakers finalize the next phase of telehealth regulations in behavioral health, providers with flexible models, strong clinical leadership, and ethical standards will be best positioned to thrive.
