TCPA Opt Out Rules Change November 25: What Practices Do Now

Updated November 2026. Written by Matteo Grassi, clinical psychologist and cofounder of HANA Health.

The FCC's new consent revocation rule is a change to the Telephone Consumer Protection Act (TCPA) rules for robocalls and robotexts, effective November 25, 2026. It lets a practice treat a patient's opt out from one informational message as covering only that category, and lets a caller designate how patients may opt out, if it discloses the method on every call or text.

Key facts

• The FCC adopted the order on September 30, 2026 as FCC 26-67, and it was published in the Federal Register on October 26, 2026 at 91 FR 67214. See the Federal Register notice.
• The amendments take effect November 25, 2026. They replace the "revoke all" requirement that the FCC had postponed to January 31, 2027, so that version never takes effect as written.
• An opt out from an informational call or text, one with no advertising or telemarketing, may be treated as covering only the category that triggered it.
• An opt out from a message that contains an advertisement or is telemarketing ends all of that caller's advertising and telemarketing calls and texts.
• A caller may designate one exclusive way to revoke consent, but it must disclose that method clearly on each call or text. The FCC lists three allowed methods.
• Revocation requests must still be honored within a reasonable time that can't exceed ten business days, per 47 CFR 64.1200.
• AI generated voices count as "artificial" voices under the TCPA, per the FCC's February 2024 declaratory ruling.

What did the FCC change about consent revocation?

The FCC changed two things that matter to practices: how far an opt out reaches, and how a patient is allowed to give it. Both sit in paragraph (a)(10) of 47 CFR 64.1200, which governs how a called party revokes consent to robocalls and robotexts.

Before this order, the 2024 rule said an opt out in response to one type of call had to be treated as an opt out of every call that needed consent. The FCC postponed that "revoke all" piece to January 31, 2027. The new order drops it for informational messages and keeps a broad opt out only for marketing.

The second change is about method. Under the 2024 text, a caller had to honor a revocation made in any reasonable way. The new rule lets a caller name an exclusive method, if the caller discloses it on each call or text. A caller that doesn't name one must keep honoring any reasonable method.

The order also asks for comment on more changes. They include the ten business day deadline, two way texting and a revoke all option. Those are proposals, not rules. Check the docket before you build around them.

Does an opt out from one patient message now stop everything?

No, not for informational messages. If a patient replies STOP to a refill reminder, a practice may treat that as covering refill reminders and keep sending other informational messages the patient still wants, such as appointment reminders.

That's the FCC's reasoning. It said an all or nothing opt out "unduly restricts consumers' ability to receive other wanted calls." The order's own example is a consumer who opts out of payment reminders and still wants other calls from the same company.

Two limits matter.

• The category rule covers informational messages only. A message that contains any advertisement or is telemarketing falls outside it. An opt out there ends all of that caller's marketing robocalls and robotexts.
• The Federal Register summary doesn't define "category." A practice that wants to use category specific opt outs should draw its categories the way a patient would see them: appointment reminders, prescription notices, care management check ins, and so on.

I'd also keep a practical caution in mind. A narrow reading of a patient's STOP is permitted, not required. If a patient's reply makes clear they want no more calls at all, ignoring that is a risk you don't need to take.

How do opt out rules work for healthcare exempt calls and texts?

The healthcare exemption has its own opt out conditions, and this order revises paragraph (a)(10), not the exemption in paragraph (a)(9)(iv). Read both together.

The exemption lets a healthcare provider send calls and texts to a wireless number without prior express consent, if every condition is met. The conditions in the current rule text include:

• Number source: only the wireless number the patient provided.
• Purposes: limited to appointment and exam confirmations and reminders, wellness checkups, hospital pre-registration instructions, pre-operative instructions, lab results, post discharge follow up intended to prevent readmission, prescription notifications, and home healthcare instructions.
• Content: no telemarketing, solicitation, advertising, billing or debt collection, and HIPAA compliance.
• Length and frequency: generally one minute or less for a call, 160 characters or less for a text, one message a day and no more than three a week per patient.
• Opt out: an easy opt out in each message. Texts must tell recipients to reply STOP, which the exemption text calls the exclusive way to opt out of those messages. Voice calls that a live person could answer need a key press opt out, and voicemail needs a toll free number.
• Timing: opt outs must be honored immediately.

A monthly chronic care management check in isn't one of the eight listed purposes. A practice that runs automated care management calls to cell phones generally can't lean on the exemption for them and needs patient consent instead. Consent is a legal question for your counsel, and the CCM consent and care plan guide covers the Medicare side of consent separately.

Can a practice choose how patients opt out?

Yes, within limits. A caller may designate any of three methods as the only way to revoke consent:

1. An automated, interactive voice or key press opt out on the call.
2. A reply text using one of seven standardized words: "stop," "quit," "end," "revoke," "opt out," "cancel," or "unsubscribe."
3. A website or telephone number the caller provides to process opt outs.

The designation only works if the caller discloses the method clearly and conspicuously on the call or in the text. A text sender that picks reply text can meet the disclosure duty by including at least one standardized word in each text, but it must still recognize all seven.

A caller that doesn't designate a method must keep processing revocations made by any reasonable means. Under paragraph (a)(11), a method outside the listed ones creates a rebuttable presumption that the patient revoked consent, if the patient can show the request was made.

One more rule is easy to miss. The existing text on revocation confirmations allows a message that only confirms the opt out and carries no marketing. Keep it to that.

What should a practice do before November 25?

You have about two and a half weeks. Here's a short checklist for any practice that sends automated calls or texts to patients, including AI voice calls.

1. List every automated message you send. Note the channel, the purpose and who sends it, whether staff, a vendor or an AI voice system.
2. Sort each one as informational or promotional. If a message mentions a service, a program or anything that reads like an offer, treat it as promotional and keep it out of reminder traffic.
3. Check whether each informational message fits the healthcare exemption. If not, confirm what consent you hold for it and where that consent is recorded.
4. Decide whether to designate an exclusive opt out method. If you do, write the disclosure into every script and text template.
5. Define your categories. Write down the categories you'll use for category specific opt outs, and make your system apply them.
6. Test the opt out paths. Send yourself a STOP, a key press opt out and a wordy "please stop texting me" and see what the system does.
7. Set the clock. Make sure each opt out is processed well inside ten business days. For exempt messages, make it immediate.
8. Ask your vendors in writing. Confirm who processes opt outs, how fast, and whether they apply category rules the way you've defined them.

The guide on business associate agreements for voice AI stacks is a useful companion for step eight.

What this means for your practice

The rule gives practices more room, and a cleaner way to prove an opt out was handled. It also puts the work on you: define categories, disclose the method, and make the system obey.

The biggest risk is the gap between what your policy says and what your messaging tools do. Opt out handling usually lives in a vendor's configuration, not in your policy binder. Test it.

HANA builds patient outreach for care management programs, and we write our scripts and opt out handling around rules like these. If you want to see how outreach fits into a care management workflow, start at the HANA Remote page. For the earlier explainer on AI calls and the healthcare exemption, read AI voice calls to patients and the TCPA. It was written before this order took effect, so use this post for the revocation rules.

Frequently asked questions

Does the new rule apply to text messages as well as calls?

Yes. The FCC's rules cover robocalls and robotexts, meaning autodialed calls and texts and calls using an artificial or prerecorded voice. The standardized reply words are the center of the text rules.

Is an appointment reminder informational or promotional?

An appointment reminder with no advertising is informational. If you add a mention of a new service, a program or a promotion to the same message, it stops being informational and the broader marketing opt out applies.

Do AI voice calls need consent under the TCPA?

The FCC ruled in February 2024 that AI technologies that generate human voices are covered by the TCPA's "artificial or prerecorded voice" rules. A call that uses one needs prior express consent unless it's an emergency or an exemption applies.

Can I send a text to confirm a patient's opt out?

The rules allow a confirmation text that only confirms the opt out and has no marketing or promotional content. It should be the only extra message you send after the request.

Where can I read the actual rule?

Start with the Federal Register notice at 91 FR 67214 and the full order, FCC 26-67. Both are linked in the sources below. Paragraph (a)(10) of 47 CFR 64.1200 holds the revocation text.

Sources

1. Federal Communications Commission, "Rules and Regulations Implementing the Telephone Consumer Protection Act of 1991, Final Rule," 91 FR 67214, October 26, 2026. Federal Register.
2. Federal Communications Commission, Report and Order and Further Notice of Proposed Rulemaking, FCC 26-67, adopted September 30, 2026. FCC.
3. Electronic Code of Federal Regulations, 47 CFR 64.1200, Delivery restrictions, current text. eCFR.
4. Federal Communications Commission, Declaratory Ruling, "Implications of Artificial Intelligence Technologies on Protecting Consumers from Unwanted Robocalls and Robotexts," FCC 24-17, 2024. FCC.
5. Federal Communications Commission, "Strengthening the Ability of Consumers To Stop Robocalls," 89 FR 15756, March 5, 2024. Federal Register.

This article is educational and isn't billing, coding, clinical or legal advice. Check current CMS guidance and your MAC before you bill, and talk to counsel about TCPA compliance. If you'd like to talk through how outreach fits your care management program, book a discovery call.