For the clinics that built their model on remote care, the calendar mattered more than usual this year. The pandemic-era telemedicine flexibilities were set to expire at the end of 2025, and ketamine clinics that prescribe by video wanted certainty. They got a reprieve. In December 2025 federal regulators extended the rules again, so remote prescribing can continue while a permanent framework stays unsettled.
This guide explains where telehealth stands for ketamine clinics in 2026, what the pending special registration rule would change, and how clinic ownership and structure fit into the compliance picture.
What You’ll Learn
- Why 2026 matters for ketamine clinics
- The DEA telemedicine extension through December 31, 2026
- Ketamine’s legal status and prescribing rules
- The pending special registration rule
- Corporate practice of medicine and MSOs
- A compliance checklist
- Frequently asked questions
Why 2026 Matters for Ketamine Clinics
The business case for many ketamine clinics depends on telehealth. Video visits widen the patient base, cut overhead, and let a clinic serve rural areas without a second office. That model only works if federal law lets a practitioner prescribe a controlled substance to a patient they have met only on screen.
Since 2020, temporary flexibilities have allowed exactly that. Each looming expiration date has forced clinics to ask whether they must suddenly require in-person visits. The latest extension pushes that question into 2027, but it does not settle it, so operators should plan for a framework that could still change.
The DEA Telemedicine Extension Through December 31, 2026
In December 2025, the Drug Enforcement Administration, together with the Department of Health and Human Services, issued a fourth temporary extension of the COVID-era telemedicine flexibilities. The extension is effective January 1, 2026 and runs through December 31, 2026, according to the DEA announcement and a companion notice from HHS.
Under the extension, DEA-registered practitioners may prescribe Schedule II-V controlled medications, ketamine included, through an audio-video telemedicine encounter without ever having conducted an in-person evaluation, as long as the prescription otherwise complies with DEA regulations and applicable federal and state law. The full text appears in the Federal Register. The word to focus on is temporary. This is a bridge, not a permanent rule.
Ketamine’s Legal Status and Prescribing Rules
Ketamine is a Schedule III controlled substance that has long been used as an anesthetic. In recent years, clinicians have also administered it off label for other conditions. Off-label use of a lawfully marketed medication is common across medicine and is generally permitted when a clinician exercises appropriate professional judgment; this article does not make any claim about medical outcomes.
What matters for compliance is that ketamine clinics sit at the intersection of two rule sets. Federal law requires proper DEA registration and adherence to controlled-substance rules, while every state adds its own telehealth standards, licensing requirements, and rules on establishing a valid practitioner-patient relationship. A clinic must satisfy the law of each state where its patients are located, not only the state where the practitioner sits.
The Pending Special Registration Rule
Regulators know the temporary approach cannot last forever. In January 2025, the DEA published a proposed rule titled Special Registrations for Telemedicine and Limited State Telemedicine Registrations. It would create special registration pathways for practitioners who prescribe controlled substances by telemedicine, with tiers tied to drug schedule and specialty, and for the first time it would require certain online platforms that connect patients with prescribers to register with the DEA.
The comment period closed in March 2025, and the proposal drew significant industry concern about its practicality. Because that debate is unresolved, the agency extended the temporary flexibilities into 2026 rather than let them lapse. For ketamine clinics, the takeaway is to watch this rulemaking closely and to design workflows that could adapt if a special registration becomes mandatory.
Business Structure: Corporate Practice of Medicine and MSOs
Regulatory compliance is only half the picture. How a clinic is owned can be just as consequential. Many states enforce the corporate practice of medicine doctrine, which bars non-clinicians from owning a medical practice or controlling clinical decisions. That rule shapes who can hold equity in a clinic and how profits may flow.
To work within it, investors often use a management services organization, or MSO, that contracts with a clinician-owned professional entity to provide non-clinical support such as billing, marketing, staffing, and real estate. The management fee must reflect fair market value and avoid unlawful fee-splitting or kickbacks. Getting this structure wrong can jeopardize licensure and payment, so clinics should build it deliberately, ideally before launch, alongside a legal review of the revenue model and clear agreements among any co-owners.
A Compliance Checklist for Ketamine Clinics
Use this as a starting framework, then tailor it with counsel to your states of operation.
- DEA registration. Confirm the prescribing practitioner and, where relevant, the clinic hold current registrations for a Schedule III substance.
- Multi-state telehealth compliance. Map the telehealth and licensing rules for every state where patients are located, not just the home state.
- Valid clinical relationship. Document how each patient relationship is established and evaluated under current standards.
- Recordkeeping and security. Maintain controlled-substance records and safeguards that satisfy DEA requirements.
- Entity structure. Confirm your ownership model fits the corporate practice of medicine rules in each state and file the right entities, including proper entity disclosures.
- Contracts and consent. Put management services agreements, vendor terms, and informed-consent forms in writing, with help to draft the contracts correctly.
- Capital and investors. If you raise money, confirm your offering fits the rules for accredited investors.
Frequently Asked Questions
Can ketamine clinics still prescribe via telehealth in 2026?
Yes. The DEA and HHS extended the telemedicine flexibilities through December 31, 2026. Registered practitioners may prescribe Schedule II-V controlled substances, ketamine included, by audio-video telemedicine without a prior in-person exam, provided all other federal and state requirements are met.
What schedule is ketamine?
Ketamine is a Schedule III controlled substance. Any clinic or practitioner that handles or prescribes it must hold the proper DEA registration and follow both federal rules and the law of every state where patients are located.
What is the DEA special registration for telemedicine?
It is a proposed framework the DEA published in January 2025 that would create special registrations for telemedicine prescribing after the temporary flexibilities end. It has not been finalized, and its future is uncertain.
Who can own a ketamine clinic?
It depends on the state. Many states apply the corporate practice of medicine doctrine, which limits ownership to licensed clinicians. Non-clinician investors often use an MSO structure, but fee arrangements must avoid unlawful fee-splitting and kickbacks.
Next Steps
The 2026 extension buys ketamine clinics time, but not permanence. Build your telehealth workflows, DEA compliance, and ownership structure to withstand a rule change, not just to pass today. Contact Howard East to have your clinic’s structure and telehealth compliance reviewed before you scale. For controlled-substance regulatory parallels in the cannabis space, the team at Cannabis Industry Lawyer tracks similar federal-versus-state tension, and Howard Law Group’s healthcare and regulatory attorneys can help with licensure questions.
This article is general information, not legal advice. No attorney-client relationship is created by reading it. Attorney Advertising.
