The expiration of the PHE on May 11 will impact temporary policies put in place for telehealth, COVID-19 vaccine coverage, and MIPS participation, among others
Feb. 24, 2023 (ACP) — As the COVID-19 public health emergency (PHE) approaches an end, the American College of Physicians is alerting members to changes that will affect the health care system as special flexibilities wind down in areas like telehealth and payments.
“Federal public health officials still consider COVID-19 to be a public health priority, but they believe that surveillance data supports transitioning out of the emergency phase,” explained David Pugach, ACP vice president for governmental affairs and public policy. As a result, the secretary of the U.S. Department of Health and Human Services has announced that the PHE will cease on May 11.
“Some of the temporary policies that were implemented based on the PHE authorization will end, but others that are still needed and either do not rely on the PHE authorization — or have been extended by Congress — will continue,” Pugach said. “For example, access to COVID-19 vaccinations and certain treatments will generally not be affected. However, there will be a transition to a more traditional model of insurance coverage for vaccines and therapeutics.”
According to the Kaiser Family Foundation, private plans and issuers will no longer have to cover COVID-19 vaccines without cost sharing, or copays, which was required under the PHE even when vaccines were provided out of network.
“Coverage for telehealth services is somewhat more complicated,” Pugach said. On the bright side, “Medicare telehealth flexibilities originally implemented under the PHE will not be affected. In a bipartisan fashion, Congress has recognized that across the country, people have come to rely on telehealth to access medical care, especially in underserved communities. As a result, Congress has authorized Medicare coverage and policies that have facilitated access and payment for telehealth services, including audio-only services, to continue through Dec. 31, 2024.”
In addition, Medicaid telehealth flexibilities will remain in place for states following the end of the PHE, while Medicare Advantage plans will set their own policies regarding coverage and payment for telehealth services. “It is also important to note that the waiver of HIPAA requirements relating to the provision of telehealth services expires with the PHE,” Pugach said.
In addition, as the Kaiser Family Foundation notes, Drug Enforcement Agency-registered clinicians will no longer be able to use telehealth to issue prescriptions for controlled substances to patients without an in-person evaluation.
Also ending with the expiration of the PHE is the requirement that Medicare Part D plans provide up to a 90-day (three-month) supply of covered Part D drugs to enrollees who request it.
The end of the PHE will also mean the lifting of a waiver that allowed patients to be transferred from hospitals to skilled nursing facilities without the requirement of a three-day inpatient hospital stay. “During the PHE, the Centers for Medicare & Medicaid Services used a combination of emergency authority waivers, rulemaking and guidance to both facilitate care and expand facility capacity, while also trying to keep people safe,” Pugach said. “This waiver was in the interest of getting people out of hospitals.”
On the payment front, “a number of Merit-based Incentive Payment System participation requirements were waived in recognition of the impact that the pandemic was having on physicians and their practices,” he noted. “These requirements will resume with the end of the federal PHE.”
Finally, under the PHE, “hospitals received a 20 percent increase in the Medicare payment rate through the hospital inpatient prospective payment system for treating patients diagnosed with COVID-19,” Pugach explained. “This payment ends with the expiration of the PHE.”
Back to the February 24, 2023 issue of ACP Advocate