The telehealth cliff

Medicare will soon require an in-person visit for new behavioral-health telehealth patients. Start them before December 31, 2027 and, under current rules, they count as established and avoid the stricter new-patient requirement.

Since March 2020, you have been able to see a new behavioral-health (BH) patient over video without ever meeting them in person. Medicare waived the old location rules during the COVID emergency, and then Congress kept the waiver alive, bill after bill, often at the last minute inside a government-shutdown fight.

The latest extension, the Consolidated Appropriations Act of 2026 (the year-end federal spending law, signed February 3), set the end date. Starting January 1, 2028, a new BH telehealth patient will need an in-person visit within the six months before their first video session, and once a year after.

Here is the part worth acting on. Under current policy, a patient who begins BH telehealth on or before December 31, 2027 counts as established, which means they skip the stricter new-patient rule (an in-person visit within the six months before the first video session). Established patients are still expected to have at least one in-person visit a year under the present policy, but they avoid the tighter onboarding requirement that applies to anyone who starts after the cliff. That is a grandfather window, and it is closing. Every eligible patient you start on telehealth before the cliff is a patient you onboard under today's lighter rules rather than tomorrow's.

Two things sit outside the cliff under current law: Medicare's removal of the old location limits for BH, and audio-only BH visits when a patient cannot do video. Both are written into the statute today, not tied to the extensions that keep expiring. The cliff is only the in-person requirement, and only for patients who start after it.

The move is simple. Onboard your eligible patients onto telehealth now, while starting them still lands them on the established-patient side of the current rules.