COVID-19 PHE ends in May. Now what?
Throughout the pandemic, the COVID-19 Public Health Emergency (PHE) has offered critical flexibilities in reimbursement for providers and access to key services for patients to keep the overwhelmed healthcare system afloat.
The PHE, and the concurrent national emergency declaration, allowed the federal government to mandate access to tests and vaccine with no cost-sharing for public or private insurance beneficiaries, significantly expand access to telehealth services to supplement in-person care, put a freeze on certain rate increases and eligibility determinations, and speed up the availability of novel tests, vaccines, and treatments for the virus.
Now that daily reported cases are down 92 percent and both hospitalizations and deaths are down approximately 80 percent since the peak of the Omicron surge in January of 2022, according to an HHS fact sheet, the federal government has declared that both the PHE and national emergency declaration will end on May 11, 2023.
“We have come to this point in our fight against the virus because of our historic investments and our efforts to mitigate its worst impacts,” said HHS officials. “Addressing COVID-19 remains a significant public health priority for the Administration, and over the next few months, we will transition our COVID-19 policies, as well as the current flexibilities enabled by the COVID-19 emergency declarations, into improving standards of care for patients. We will work closely with partners, including state, local, Tribal, and territorial agencies, industry, and advocates, to ensure an orderly transition.”
The transition won’t reset everything back to the pre-COVID status quo, however. The PHE wasn’t the only regulatory tool used to combat COVID-19, and some of the most popular changes of the pandemic era will still remain in place – at least for a while. The return to normalcy will happen in stages as various laws, rules, and regulations come to an end at different points.
Here’s a breakdown of some of the major regulations and flexibilities that will and will not be affected by the end of the PHE in May.
What’s about to change
- Cost sharing for testing: Traditional Medicare will no longer cover the costs of purchasing at-home testing kits. Medicare Advantage (MA) and commercial insurance plans will no longer be required to cover these costs, but may choose to continue doing so. All state Medicaid programs will continue to cover costs through September of 2024, but can choose to implement cost sharing after that.
In addition, PCR tests ordered by a physician will also incur more out-of-pocket costs in most situations. Medicare may charge for the associated physician visit, while MA and private insurance can also start to require cost sharing or put limits on the number of available tests.
- Telemedicine: Some aspects of the telemedicine environment are about to change, including the ability for providers to dispense controlled substances via telehealth without an in-person visit. In-person visits will be required again starting on May 11. In addition, providers will once again need to ensure that their telehealth technologies are fully HIPAA compliant. Some states have also tied expanded licensure policies to the PHE. In these areas, providers may lose the ability to practice across state lines using telehealth.
On December 31, 2023, reimbursement parity for telehealth services that would typically have been performed in person will also end. Other telehealth flexibilities are scheduled to end at later dates, including location waivers, reimbursement for some functional and occupational therapy services, and clinical care provided by FQHCs and rural health clinics.
- CDC lab data reporting: With the end of the PHE, HHS will no longer have express authority to require laboratory and immunization data reporting to the CDC. This may affect the reporting of negative tests, which could skew data on positivity percentages and limit insight into local and national trends. Hospital data reporting will continue through April 30, 2024, but the required frequency may change.
- Reimbursement: Medicare will no longer provide a 20 percent add-on payment to hospitals for patients diagnosed with COVID-19 to offset the complexity of treating individuals with the disease. On December 31, 2023, enhanced federal Medicaid funding of 6.2 percent will also end.
- Site of care flexibilities: Health systems will no longer be allowed to use temporary expansion sites, such as convention centers, to provide care and will be required to end the use of provider-based departments that were moved to settings outside of the hospital due to extraordinary circumstances waivers. Hospitals will no longer be able to direct patients out of emergency departments to screening tents for COVID-19 testing.
What’s staying the same
- Cost sharing for vaccines and some treatments: Vaccines will continue to be available to all without cost sharing as long as federal supplies of the vaccines last. Any pharmaceutical treatment purchased by the government, including Paxlovid and Lagevrio, will also continue to be available without cost sharing until doses run out.
- Some telehealth flexibilities: Most of the major Medicare and Medicaid telehealth flexibilities will remain in place through at least December of 2024. States already have significant opportunities to customize their Medicaid telehealth offerings and will continue to have options through state plan amendments and waivers.
Providers will continue to be allowed to prescribe buprenorphine via telehealth as part of an opioid treatment program (OTP) without an initial in-person visit. Similarly, OTP patients will still be allowed access to an increased number of take-home methadone doses to support ongoing treatment.
- FDA Emergency Use Authorizations (EUAs) for COVID-related products: The end of the PHE will not affect the FDA’s emergency authorization process for COVID-19 treatments, vaccines, and tests. Existing EUAs will still remain in effect and the FDA may issue new EUAs for products that could significantly aid the efforts to control the virus.
What healthcare leaders need to do now
The PHE is the first significant pandemic-era framework to be put to rest, but the healthcare industry isn’t just flipping a switch that will take it back to 2019. Over the past three years, Congress and state lawmakers have passed a number of different legislative packages that have shifting deadlines around and made certain provisions permanent.
Healthcare executives will need to ensure they fully understand which surviving state and federal flexibilities pertain to their organizations and how the interplay of these factors will affect their reimbursement rates and their ability to deliver care to their patient populations.
Leaders should also take this opportunity to collaborate with national and local regulators on keeping strategies that could continue to improve care in the post-pandemic era, such as the patient-approved expansion of telehealth, particularly in rural and underserved areas.
While navigating this new landscape may be challenging, the end of the PHE signals good news for the fight against COVID-19 and indicates that the nation may have turned the corner after one of the most difficult periods in recent healthcare history.
Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system. She can be reached at firstname.lastname@example.org.