The behavioral health landscape is facing a period of profound uncertainty. As COVID-era regulations expire and unresolved legislative questions linger, providers across the spectrum—from traditional addiction treatment facilities to digital telehealth operators—are confronting new challenges that could reshape patient access, revenue models, and operational practices. In this environment, telehealth addiction treatment post-COVID is becoming a focal point for both opportunities and regulatory concerns.
COVID-Era Flexibilities and the Ryan Haight Act
During the COVID-19 pandemic, federal authorities temporarily lifted certain restrictions under the Ryan Haight Act, which normally requires an in-person assessment before prescribing controlled substances. This measure was part of the public health emergency (PHE) declaration and enabled telehealth providers to prescribe critical behavioral health medications remotely.
Key controlled substances include:
- Buprenorphine, essential for treating opioid use disorder (OUD)
- Adderall, a potent stimulant used for ADHD
- Alprazolam (Xanax), commonly prescribed for anxiety disorders
These medications are tightly regulated by the Drug Enforcement Administration (DEA) due to their potential for misuse. Lifting the in-person assessment requirement allowed telehealth providers to expand access to care during a period when in-person visits were challenging or impossible. As the PHE concluded, the uncertainty surrounding the continuation of these flexibilities has put telehealth addiction treatment post-COVID in the spotlight.
The Rise and Scrutiny of Digital Behavioral Health Providers
Digital behavioral health providers thrived during the pandemic. Startups like Ophelia Health, Cerebral Inc., Done Global, and Medvidi expanded rapidly, offering remote therapy and medication management to patients across multiple states. Venture capital investments flowed into these companies, reflecting confidence in telehealth as a lasting solution for behavioral health care.
However, scrutiny has followed this growth. Cerebral, for example, discontinued most of its controlled substance prescriptions after criticism over its prescribing practices and the looming end of PHE flexibilities. Federal investigations into companies like Cerebral, Done Global, and Medvidi highlight the regulatory uncertainties surrounding digital behavioral health. These developments underscore the challenges of scaling telehealth addiction treatment post-COVID responsibly.
Emily Behar, vice president of clinical operations for Ophelia Health, explains the challenge succinctly:
“There is a lot of concern and anxiety around what’s going to happen… there are undue fears that can also come with this because we and many other telehealth practitioners have been practicing for a number of years now with a tremendous amount of success.”
Retail Pharmacy Policies Complicate Virtual Care
Telehealth providers also face operational hurdles due to retail pharmacy restrictions. Major chains, including Walmart and CVS Health, have tightened requirements for filling controlled substance prescriptions from virtual providers.
- Walmart requires in-person exams within the last two years and empowers pharmacists to exercise discretion in filling telehealth prescriptions.
- CVS Health reviews telehealth providers on a case-by-case basis, currently refusing controlled substance prescriptions from Cerebral, Done Global, and Medvidi.
These changes coincide with ongoing legal scrutiny over opioid dispensing. In September, West Virginia settled with CVS and Walmart for $147 million over their handling of opioid painkillers, adding another layer of caution for pharmacies when reviewing prescriptions from telehealth companies.
Behar emphasizes the operational friction this creates:
“What we want is for pharmacists and pharmacies to be on the same team with us. But they can also prove to be really strong barriers for us.”
The Medicaid Factor: A Critical Payer
Medicaid is the single largest payer for behavioral health services, according to CMS. Uncertainty surrounding Medicaid eligibility post-pandemic poses a major threat to both patient access and provider revenue.
The federal government paused Medicaid eligibility determinations during the PHE, and millions of individuals may lose coverage as states resume normal operations. Estimates suggest up to 15 million people nationwide could lose Medicaid coverage post-PHE, creating significant risk for behavioral health providers reliant on this payer.
Nick Stavros, CEO of Community Medical Services, an opioid treatment program operator, identifies Medicaid coverage as a top concern:
“There’s no way to tell for us how many of our patients are at risk of falling off Medicaid. That’s something we’re trying to understand and play an active role trying to make sure we’re doing our part communicating with patients and helping facilitate them getting coverage.”
As this landscape evolves, telehealth addiction treatment post-COVID strategies must account for the potential loss of Medicaid coverage to maintain continuity of care.
The Stakes for Opioid Treatment Programs
Traditional opioid treatment programs, such as Community Medical Services, rely less on telehealth flexibilities than digital startups because certain services, like methadone administration, legally require in-person visits. Methadone is highly regulated, but it remains one of the most effective treatments for OUD, especially for patients using fentanyl, a synthetic opioid involved in the majority of recent overdose deaths.
SAMHSA has extended some COVID-era flexibilities for OTPs, allowing:
- Buprenorphine prescriptions via telemedicine without in-person exams for up to a year
- Counseling and therapy via audio-visual telehealth
However, audio-only sessions will no longer be permissible, reflecting a partial rollback of pandemic-era rules. OTPs also continue to advocate for telehealth intake exams for methadone, which remain restricted, despite rising fentanyl-related overdoses. This regulatory landscape directly impacts telehealth addiction treatment post-COVID, as providers look for ways to integrate remote care while complying with federal rules.
Federal and Legislative Efforts to Address Telehealth
Congress and federal agencies have taken steps to codify some telehealth flexibilities, though permanent resolution remains elusive:
- Consolidated Appropriations Act 2022 allows Medicare tele-behavioral health visits to continue for 151 days post-PHE.
- Advancing Telehealth Beyond COVID-19 Act of 2022 extends certain Medicare telehealth flexibilities through 2024.
Experts caution that the DEA’s delayed creation of a special telehealth registration for controlled substances could further complicate care. If the registry mirrors pre-COVID requirements, virtual providers may face significant barriers, limiting the scope of telehealth addiction treatment post-COVID.
Preparing for a Post-PHE World
Behavioral health operators are adapting in several ways:
- Data-driven advocacy: Companies like Ophelia Health are sharing outcomes and operational data with policymakers to influence regulations.
- Contingency planning: Preparing for the resumption of in-person requirements through partnerships with local providers and potential office openings.
- Patient support: Proactively helping patients maintain Medicaid coverage to avoid interruptions in care.
As the federal government and Congress continue to navigate telehealth regulations, providers must remain agile. Operational adaptability, coupled with advocacy and patient support, will be key to sustaining access to care in the evolving regulatory environment.
Looking Ahead: The Future of Behavioral Health
The post-pandemic era presents both challenges and opportunities for behavioral health providers:
- Telehealth remains a powerful tool, particularly for patients reluctant or unable to seek in-person care.
- Regulatory uncertainty around controlled substances and Medicaid coverage creates operational risk.
- Traditional OTPs continue to rely on in-person care for certain services, but telehealth expansions could enhance access if made permanent.
Resolving these issues will require coordinated efforts from Congress, federal agencies, and industry stakeholders. For patients, the outcome will directly influence the availability of life-saving treatments and behavioral health services. For providers, clarity on telehealth flexibilities, Medicaid coverage, and controlled substance regulations will be critical to long-term sustainability.
Ultimately, telehealth addiction treatment post-COVID has the potential to transform behavioral health, but its success hinges on regulatory clarity, operational adaptability, and patient-centered strategies.
