SAVE THE DATE! Please reserve October 30 from 1:45- 3:00 for an important NYS Council All Member virtual meeting with Senator Nathalia Fernandez, Chair, Senate Committee on Alcoholism and Substance Use Disorders Committee. Zoom link for this meeting to follow shortly.
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This is an Update prepared for the members of the NYS Psychiatric Association by NYSPA. Thought it might be helpful to share:
October 16, 2025
Coverage of Telehealth Mental Health Services under the Medicare Program
6-Month Rule
As of October 1, 2025, the federal requirement to see all new Medicare patients at least once in-person during the 6 months prior to initiating mental health telehealth services (and again every 12 months) is now in effect. However, CMS has clarified that if a patient has previously been seen via telehealth prior to 10/1/25, that patient will be deemed an “established” patient and the 6-month rule will not apply. As a result, the 6-month in-person requirement applies only to new patients seen on or after 10/1/25. To confirm, all new patients seen on or after 10/1/25 must be seen in-person during the 6-month window prior to an initial telehealth visit. For practical purposes, this means that the initial visit with a new Medicare patient must be in-person, with any telehealth follow-ups taking place within 6 months of the initial in-person visit.
12-Month Rule
Under the 12-month rule, effective 10/1/25, all mental health telehealth patients will need to be seen in person at least once every 12 months. However, if a patient is already being seen via telehealth and in-person care may not be appropriate, an exception may apply, as follows:
- An in-person service is likely to cause disruption in service delivery;
- An in-person service has the potential to worsen the patient’s condition;
- If patient is in partial or full remission and only requires maintenance level of care;
- Patient is clinically stable and in-person visit has risk of worsening patient’s condition, creating undue hardship on self or family; or
- Patient is at risk for disengagement with previously effective care.
The basis for the exception must be noted in the patient record.
Additional Important Items
- If you work in a federally-qualified health center or rural health center, the 6-month and 12-month in-person visit requirements will not take effect until January 1, 2026.
- Please note that the 6-month and 12-month rules apply to mental health treatment and not to substance use disorder (SUD) treatment. At the moment, there is no Medicare requirement for in-person visits for SUD treatment.
- We would also like to remind members that all COVID-related DEA waivers (including waiver of the Ryan Haight Act in-person visit requirement and waiver of the DEA state registration requirement) will expire on December 31, 2025. As of this writing, the DEA has not issued any updates regarding the issuance of final rules or additional extensions. We will provide members with any further information as soon as it is made available.
- By way of reminder, the Medicare program has been permanently updated to permit telehealth for behavioral/mental health services in the patient’s home.
- Behavioral/mental health services may be delivered via audio-video telehealth technology or audio-only communications. Audio-only may be used when the patient does not have access to two-way, audio-video technology. Such circumstances should be noted in the patient record.
And this is an update to information that began circulating yesterday and that we sent to all members this morning. Again, this is an update to previous info shared.
Medicare Aborts Apparent Plan to Pause All Physician Payments During Shutdown
by Shannon Firth, Washington Correspondent, MedPage Today
October 16, 2025 • 2 min read
Amid the federal government shutdown, the Centers for Medicare & Medicaid Services (CMS) on Wednesday appeared to announce a pause on all Medicare payments to doctors, but then quickly backed off.
An initial notice stated that CMS had instructed all Medicare Administrative Contractors to temporarily hold “all claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and all Federally Qualified Health Center claims” with dates of service of Oct. 1 and later. “Providers may continue to submit these claims, but payment will not be released until the hold is lifted.”
But within hours, the agency issued another notice saying it would only stop processing claims related to expired programs such as certain telehealth and hospital-at-home services, both of which had been expected ahead of the shutdown.
“CMS will continue to process and pay held claims in a timely manner with the exception of select claims for services impacted by the expired provisions,” CMS said, adding that no payments had been delayed yet.
The agency explained that in light of the government shutdown, “many of the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 Public Health Emergency took effect again for services that are not behavioral health services. These include prohibition of many services provided to beneficiaries in their homes and outside of rural areas, and hospice recertifications that require a face-to-face encounter.”
As a result, practitioners performing telehealth services that are not currently payable by Medicare should consider providing beneficiaries with an advance notice of noncoverage, CMS advised.
Medicare Aborts Apparent Plan to Pause All Physician Payments During Shutdown | MedPage Today
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A California judge has issued a temporary restraining order stopping federal agencies from carrying out layoffs during the ongoing government shutdown. The order came after two major government worker unions sued the Trump administration, arguing that it was using the shutdown to execute reductions in force (RIFs) that had already begun at agencies, including the Department of Health and Human Services. The judge ordered federal agencies to halt further RIFs, provide details on cuts already made, and not implement additional layoffs while the order is in effect. Union leaders praised the ruling, calling the planned terminations unlawful and harmful to public servants, and a hearing on a preliminary injunction is scheduled for a later date. (Article here)
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OMH Funding Opportunity: Youth Assertive Community Treatment team in Central or Western NY
The New York State Office of Mental Health has issued a Request for Proposal to develop one new Youth Assertive Community Treatment team in either the Central New York or Western New York regions.
Youth ACT teams are designed to address the significant needs of children ages 10 to 21, who are at risk of entering, or returning home from high intensity services, such as inpatient settings or residential services. Interventions are focused on enhancing family functioning to foster health and well-being, stability, and re-integration for the child and youth. Youth ACT teams deliver intensive, highly coordinated, individualized services and skilled therapeutic interventions through an integrated, multi-disciplinary team approach to better achieve success and maintain the child in the home, school, and community.
The Request for Proposal can be found at: https://omh.ny.gov/omhweb/rfp/2025/yact/index.html
Proposals must be submitted by the date and time posted within this RFP.
All questions must be submitted through the Issuing Officer as identified in the RFP.
OMH Funding Opportunity: Afghan Refugee Health Program
The New York State Office of Mental Health has issued a Request for Proposal to promote health literacy, coordination of mental health services, and facilitation of wellness group activities for Afghan individuals and families.
As Afghan communities continue establishing themselves in the United States, it is critical to ensure that they have access to timely, culturally responsive, and linguistically appropriate mental health care. Additionally, mental health providers, interpreters, and Disability Assistance partners serving Afghan populations should be knowledgeable about the cultural contexts and unique challenges that may affect access to and engagement with services.
OMH will be allocating funding for mental health promotion efforts that increase awareness, improve care coordination, and enhance the delivery of quality mental health services to Afghan communities throughout New York State.
Full details can be found in the RFP document located here: https://omh.ny.gov/omhweb/rfp/2025/arhp/index.html