The telehealth industry experienced unprecedented regulatory flexibility during the COVID-19 pandemic. Emergency waivers expanded access, loosened geographic restrictions, and allowed prescribing without in-person visits. But as we move into 2026, the regulatory landscape is shifting again—and healthcare founders need to understand what is changing, what is becoming permanent, and where new regulation is emerging.
This guide covers the most significant telehealth regulatory trends that will shape the industry in the coming years.
Expiring Pandemic Waivers and What Replaces Them
Many of the telehealth flexibilities introduced during the public health emergency were temporary. While Congress has extended several key provisions, the long-term status of these waivers remains uncertain.
- Medicare geographic and originating site restrictions: During the pandemic, Medicare beneficiaries could receive telehealth services from their homes anywhere in the country. Extensions have kept this flexibility alive, but permanent legislation remains elusive.
- Audio-only telehealth coverage: CMS expanded coverage for audio-only visits, which proved critical for patients without broadband access. Many states have codified audio-only parity, but federal policy continues to evolve.
- Provider type expansions: The pandemic allowed additional provider types—such as physical therapists and occupational therapists—to deliver telehealth. Some of these expansions have sunset provisions.
The biggest risk for telehealth companies is building a business model on regulatory flexibility that may not be permanent. Founders should track waiver expiration dates and build contingency plans for each scenario.
DEA Telehealth Prescribing Rules
One of the most consequential regulatory developments for telehealth is the DEA's approach to prescribing controlled substances via telemedicine. The Ryan Haight Act has long required an in-person examination before prescribing controlled substances, but pandemic-era waivers suspended this requirement.
The DEA has proposed a framework that would allow initial telehealth prescriptions for Schedule III-V substances under certain conditions, while maintaining stricter requirements for Schedule II substances. Key elements of the evolving framework include:
- Registration requirements: Providers may need a special DEA telehealth registration to prescribe controlled substances without an in-person visit.
- Prescription limits: Initial telehealth prescriptions for controlled substances may be limited to a 30-day supply before an in-person visit or referral is required.
- State-level variation: States retain the authority to impose additional restrictions, creating a patchwork that multi-state telehealth companies must navigate.
- Platform requirements: The DEA may require that telehealth platforms meet certain technical standards for identity verification and record-keeping.
For companies in the mental health, pain management, or weight loss telehealth space, these rules will directly impact their operating model and clinical protocols.
State Legislative Trends
While federal policy gets the most attention, state legislatures are actively shaping the telehealth regulatory environment. Several trends are emerging across states:
- Telehealth-specific licensure pathways: Some states are creating expedited or temporary licensure categories specifically for out-of-state telehealth providers, reducing the barrier to multi-state practice.
- Informed consent requirements: An increasing number of states require specific telehealth-related informed consent disclosures beyond standard medical consent.
- Parity law refinement: States continue to refine telehealth parity laws, with some expanding from coverage parity to full payment parity.
- Standard of care clarification: Several states have enacted laws confirming that the standard of care for telehealth visits is the same as for in-person visits, while others have introduced telehealth-specific standards.
Interstate Compacts and Multi-State Practice
Interstate licensure compacts are expanding, which is significant for telehealth companies seeking to scale nationally. The Interstate Medical Licensure Compact (IMLC) now includes a majority of states, and similar compacts exist for nursing (NLC), psychology (PSYPACT), physical therapy, and counseling.
For 2026 and beyond, several developments are noteworthy:
- New states joining existing compacts: Several states have pending legislation to join compacts they have not yet adopted.
- New professional compacts: Compacts for social work and other professions are in development, which will expand the range of providers who can practice across state lines.
- Compact limitations: Compacts do not override CPOM laws. Even if a physician holds a compact license, the telehealth company must still comply with the corporate practice of medicine doctrine in each state where it operates.
AI Regulation in Telehealth
As telehealth platforms increasingly incorporate artificial intelligence—for triage, documentation, diagnostic support, and treatment recommendations—a new layer of regulation is forming. Healthcare founders should be tracking several areas.
The FDA is developing regulatory frameworks for AI/ML-based software as a medical device (SaMD), which may apply to clinical decision support tools embedded in telehealth platforms. States are beginning to require disclosure when AI is used in clinical decision-making. And CMS is evaluating how AI-assisted visits should be documented and billed.
The companies best positioned to navigate AI regulation are those that treat AI tools as clinical aids—subject to the same validation, documentation, and oversight standards as any other clinical tool—rather than autonomous decision-makers.
What This Means for Telehealth Founders
The telehealth regulatory environment in 2026 is more complex than it was during the pandemic, but it is also more mature. Founders who stay ahead of these trends can build sustainable, compliant businesses. The key principles remain the same: build on a solid corporate structure, maintain state-by-state compliance, and design your clinical model to work within the most restrictive regulatory scenario you may face.
Regulatory uncertainty is not a reason to avoid telehealth. It is a reason to invest in compliance infrastructure that gives you the flexibility to adapt as the rules evolve.