The Service Line

Rules. Money. Medicine. Decoded daily.

The White House is holding another stakeholder meeting on the DEA’s telemedicine prescribing rule at 1:30 p.m. today, and virtual psychiatry has 49 days of runway left

The Drug Enforcement Administration’s final rule on special registrations for telemedicine (RIN 1117-AB40) has sat at the White House Office of Information and Regulatory Affairs since August 25. The OIRA review record lists it as economically significant, and the OIRA meeting log shows completed stakeholder sessions through November 2 and one set for today. The current flexibilities that let clinicians prescribe controlled substances by video without a prior in-person visit run only through December 31, 2026. The rule text is not public, so no operator can yet say what a special registration will require. We covered the cliff on October 29; the development is that review is still open and the meeting calendar is still filling. Frier Levitt’s tracker speculates that DEA and the Department of Health and Human Services could issue another interim extension; nothing announced supports that yet. So-what: any virtual-first psychiatry group or stimulant-prescribing program should have a Plan B for January 1 on paper now. Confidence: High on review status, Low on whether an extension follows.

Reimbursement

Medicare’s final 2027 outpatient rule keeps the two-tier intensive outpatient and partial hospitalization structure, and hands facilities a 2.3% update

The CY2027 OPPS and ASC final rule fact sheet (CMS-1850-F, November 4) keeps two payment tiers each for intensive outpatient program (IOP) and partial hospitalization program (PHP) services, for hospitals and for community mental health centers (CMHCs). CMHC costs stay at 40% of hospital-based costs, which is why CMHC per diems run far below hospital rates for the same program. IOP still requires at least nine hours of services a week and PHP at least 20, and IOP can be delivered in hospital outpatient departments, CMHCs, federally qualified health centers, rural health clinics, and opioid treatment programs. The fact sheet gives no dollar per diems; those sit in the rule’s addenda, so check the final rate tables before you reprice a program. Separately, the rule pays 340B-acquired drugs at average sales price minus 28%, which squeezes hospital-based clinics that lean on 340B margin. Confidence: High on structure, rates not verified this run.

Enforcement

Two executives of a D.C. mental health provider are indicted for billing Medicaid for juvenile services never provided or billed at inflated rates

A 10-count indictment announced November 5 charges two executives and a community support worker with defrauding D.C. Medicaid of what prosecutors call millions of dollars, per the HHS Office of Inspector General enforcement listing and the U.S. Attorney’s Office release. No exact dollar figure is published and the charges are allegations. The pattern, community-based services to minors billed on volume with thin documentation, is the same one state Medicaid fraud units screen for with impossible-day and units-per-day analytics. So-what: community support and rehabilitation services need contemporaneous notes that tie each billed unit to a named worker and a date. Confidence: High on the charges, Low on scale.

Who’s Buying

The virtual-reality therapy company XRHealth bought the virtual addiction treatment provider PursueCare, its second deal in November

Behavioral Health Business reports XRHealth acquired PursueCare, which accepts private insurance, Medicare and Medicaid, along with its Harvest Bio subsidiary, holder of the FDA-authorized RESET and RESET-O digital therapeutics originally developed by Pear Therapeutics. Terms were not disclosed; the trade report cites a public securities filing showing about $16.25 million in XRHealth stock issued to the sellers of PursueCare and Harvest Bio. XRHealth says its clinical footprint grew from 22 states to 40 this year. In the quarter that just closed, Mertz Taggart’s Q3 report counted 8 addiction treatment deals, up from 2 in Q2, including Spero Health’s purchase of CleanSlate Centers (128 locations in 10 states). So-what: virtual addiction care is being rolled into payer-contracted platforms, so independent telehealth OTP-adjacent practices are becoming add-on targets. Confidence: Medium on the stock figure (secondary report of a filing).

Clinical Policy

The substantive clinical-policy movement this window is the DEA item in the lede. Nothing else new surfaced that changes utilization or staffing economics this week.

The Operator Metric

Half of Q3’s traditional behavioral health deals were sponsor-backed add-ons, up from 9 of 23 in Q2

Mertz Taggart counted 33 closed transactions in July through September: 28 traditional deals (14 sponsor-backed add-ons, versus 9 of 23 in Q2) and 5 growth rounds totaling about $73.4 million. Mental health deals reached 24, the most since Q1 2025, driven by outpatient psychiatry tuck-ins. Autism and developmental disability deals fell to 6 from 10 a year earlier. Traditional deal count was 8 below Q3 2025 (36). So-what: track add-on share in your own market. When half of closings are platforms buying small practices, a 5 to 25 clinician psychiatry group has a live exit path; ABA does not, on this count. Confidence: Medium, as the firm’s tally depends on public announcements.