Business & Professions Code §2290.5

• Recognizes telehealth as a legitimate method of healthcare delivery.

• Requires informed consent.

• Requires providers to maintain applicable professional standards.

• Does not impose a general annual in-person appointment requirement.

https://codes.findlaw.com/ca/business-and-professions-code/bpc-sect-2290-5/

Welfare & Institutions Code §§14132.72 and 14132.725

• In-person contact is not generally required for covered services appropriately provided through telehealth.

• DHCS cannot require documentation of a barrier to in-person care as a condition of Medi-Cal telehealth coverage.

• New patient relationships generally require synchronous video.

• Audio-only establishment is permitted under specific exceptions, including sensitive services and circumstances where the patient requests audio-only or attests to lacking video access, subject to DHCS requirements.

• Providers must meet applicable standards of care and billing requirements.

• Providers offering synchronous telehealth must maintain procedures for offering or facilitating access to in-person care.

FQHCs have additional requirements, including specific billing and established-patient rules. See W&I Code §14132.100 and the DHCS FQHC/RHC Provider Manual.

https://codes.findlaw.com/ca/welfare-and-institutions-code/wic-sect-14132-72/

https://codes.findlaw.com/ca/welfare-and-institutions-code/wic-sect-14132-725/

https://codes.findlaw.com/ca/welfare-and-institutions-code/wic-sect-14132-100/

https://www.dhcs.ca.gov/providers-partners/telehealth-frequently-asked-questions/ 

There is no general federal requirement that Medicare patients attend an in-person appointment annually to continue receiving ordinary medical care through telehealth.

Through December 31, 2027:

• Patients may receive eligible non-behavioral health telehealth services at home without geographic originating-site restrictions.

• Eligible providers, including FQHCs and RHCs, may provide qualifying telehealth services.

• Audio-only telehealth is also permitted under applicable conditions.

These are temporary flexibilities and should not be confused with permanent Medicare policy.

FQHC virtual communication services have separate prior face-to-face visit billing requirements. These do not automatically apply to ordinary scheduled medical telehealth appointments.

https://www.cms.gov/files/document/telehealth-faq-updated-10-09-2026.pdf 

https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-payment-policies 

Medicare's in-person requirements for mental health telehealth are suspended through December 31, 2027.

Under currently scheduled rules beginning in 2028:

• New patients generally require an in-person visit within six months before beginning Medicare mental health telehealth.

• Established patients generally require an in-person visit at least once every 12 months.

• Patients who began mental health telehealth on or before December 31, 2027, are considered established and are not subject to the initial six-month requirement.

• An exception to the recurring 12-month requirement applies when the patient and practitioner agree that the risks and burdens of an in-person visit outweigh its benefits, and the practitioner documents the rationale.

• If the treating practitioner is unavailable, another practitioner of the same specialty within the same group practice may satisfy the recurring requirement.

For severe ME/CFS, post-exertional symptom exacerbation and prolonged deterioration following travel are relevant considerations when documenting the medical exception.

Regulations:

https://www.ecfr.gov/current/title-42/section-410.78 

https://www.ecfr.gov/current/title-42/section-405.2463 

CMS guidance:

https://www.cms.gov/files/document/telehealth-faq-updated-10-09-2026.pdf 

Under the DEA/HHS Fourth Temporary Extension (90 FR 61301), clinicians may prescribe Schedule II-V controlled substances through audio-video telehealth without a prior in-person evaluation through December 31, 2026, provided applicable conditions are met.

A permanent DEA Special Registration final rule is under federal regulatory review and has not yet been published as of this guide's date. Providers and patients should verify the requirements applicable after December 31, 2026.

• Federal Ryan Haight Act requirements concern controlled substances, not routine medical appointments or non-controlled prescriptions.

• Examples of controlled medications include stimulants and benzodiazepines.

• Under the baseline Ryan Haight Act, the general requirement is one prior in-person medical evaluation, not an annual recurring visit.

• Separate California prescribing and professional practice requirements may apply.

Official reference:

https://www.federalregister.gov/documents/2025/12/31/2025-24123/fourth-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled

https://www.reginfo.gov/public/do/eAgendaViewRule?RIN=1117-AB40&pubId=202510 

Two California statutes directly address this issue:

• Health & Safety Code §1374.13(c): Health care service plans cannot require in-person contact between a provider and patient before paying for covered services appropriately provided through telehealth.

• Insurance Code §10123.85(c): Establishes the corresponding protection for health insurers.

Both provisions are subject to applicable contract terms and their respective reimbursement statutes.

Additional protections:

• H&S Code §1374.14 addresses reimbursement parity and telehealth coverage.

• Insurance Code §10123.855 provides corresponding protections, including prohibiting coverage exclusively through selected third-party corporate telehealth providers.

ERISA limitation: California insurance statutes generally do not regulate self-funded employer health plans subject to ERISA. Fully insured employer plans are generally subject to applicable California insurance requirements.

These statutes do not force providers to use telehealth when they determine it is clinically inappropriate.

Statutory references:

https://codes.findlaw.com/ca/health-and-safety-code/hsc-sect-1374-13/ 

https://codes.findlaw.com/ca/health-and-safety-code/hsc-sect-1374-14/  

https://codes.findlaw.com/ca/insurance-code/ins-sect-10123-85/

https://codes.findlaw.com/ca/insurance-code/ins-sect-10123-855/

Federal disability laws may require healthcare providers to make reasonable modifications to policies and practices for patients with disabilities.

Relevant laws include:

• Americans with Disabilities Act (ADA), Titles II and III.

• Rehabilitation Act §504.

• Affordable Care Act §1557, where applicable.

A requested modification may be denied when it would fundamentally alter the service or impose an undue financial or administrative burden under the applicable legal standard. Clinical necessity and other legal requirements must also be considered.

For patients with severe ME/CFS, accommodations may include:

• Video or telephone appointments when clinically appropriate.

• Avoiding unnecessary in-person appointments.

• Flexible scheduling.

• Minimizing travel and physical exertion.

• Considering the risk of post-exertional symptom exacerbation.

• Coordinating necessary in-person services to minimize repeated trips.

A patient's physical ability to make a trip does not, by itself, establish that doing so is medically reasonable.

References:

https://www.ada.gov/topics/telehealth/ 

https://www.hhs.gov/civil-rights/for-individuals/disability/ 

There is no blanket federal or California law requiring every patient to attend an in-person medical appointment annually.

Providers must distinguish between:

• Clinical requirements.

• Insurance reimbursement rules.

• Medicare-specific telehealth requirements.

• FQHC-specific billing requirements.

• Controlled-substance prescribing rules.

• Disability accommodation obligations.

When denying a telehealth appointment because of an alleged legal requirement, providers should identify the specific applicable statute, regulation, or payer policy.

For ME/CFS patients: Travel and in-person appointments can cause substantial post-exertional symptom exacerbation and prolonged deterioration. These consequences should be considered when determining clinical necessity and evaluating disability accommodation requests.