On July 15, 2022, the U.S Secretary of Health and Human Services renewed the public health emergency (PHE) posed by COVID.1 These last-minute renewals have given healthcare workers and managers more resources to treat COVID patients, offering a range of expanded healthcare options and flexibility on everything from telehealth rules to Medicaid access.2 It is currently effective through October 13, 2022.
At some point, the emergency declaration will end. Healthcare plan and facility administrators are concerned that the end of the PHE could bring confusion and treatment limitations for facilities and patients who are not following the policy changes closely.
Now, the question is: what will coping with the expiration of the COVID Public Health Emergency look like?
The PHE Rebound
The pandemic struck suddenly and affected so many. It quickly tested the strength of healthcare systems across the globe and put an unbearable strain on healthcare resources and healthcare staff. The pandemic exacerbated existing tensions in our healthcare infrastructure and culminated in overwhelming demands, workloads, and health risks for healthcare providers (HCPs).3 And while the designation of a PHE is designed to help absorb some of the costs associated with the pandemic, it’s unclear what healthcare will look like when the PHE ends. Healthcare plan sponsors and administrators need a game plan that allows facilities and staff to adjust to the changing healthcare landscape while still treating patients as new COVID variants continue to emerge.
What will change when the formal PHE ends?
Quite honestly, it’s not entirely clear what will change when the formal PHE ends. This picture is still developing and will, no doubt, be influenced by any number of factors. However, there are some indications that it’s worth considering the following:
COVID testing, vaccines, and treatment
Healthcare plans may no longer be required to cover COVID diagnostic testing (either in-office or over-the-counter). Instead, they may be able to institute cost-sharing measures (such as deductibles and co-pays) and require prior authorization.4 In addition, plans may no longer be required to pay for COVID vaccines or boosters from out-of-network providers and may be able to institute cost-sharing measures on these as well. For those without commercial insurance, Medicaid may no longer cover these services.5
However, Medicare Plan B will likely continue to cover vaccines and clinical testing under the CARES Act.6 Individual state Medicaid programs and programs may also continue the coverage if they choose.7 Similarly, COVID-19 vaccines for children ages five and older are included in the federally funded Vaccines for Children program as well as the Children’s Health Insurance Program (CHIP) and will likely continue to be funded through these programs.8
Remote care services, such as telehealth, may be rolled back and offered only to those whose healthcare plans cover them. That said, given the popularity of telehealth services amongst patients and clinicians alike, the continued provision of remote telehealth services continues to be a very hot topic.9 The uncertain future of telehealth is illustrated, for example, in that Medicare patients are now permanently eligible to receive behavioral healthcare via telehealth in their homes if they meet certain conditions. Additionally, coverage of video-based mental health visits for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will continue on a permanent basis.10 However, providers permitted to conduct telehealth appointments for nursing home residents during the COVID PHE will have to return to in-person visits.11
Remember as well that throughout the COVID PHE, the Centers for Medicare and Medicaid (CMS) waived requirements that limited the types of practitioners that could bill for their telemedicine services through Medicare. This allowed previously ineligible practitioners such as physical therapists, occupational therapists, and speech-language pathologists to receive payment from Medicare for their services.12 Whether therapists will be permitted to use telehealth to offer therapy services in the future has yet to be determined.
It’s also worth noting that because telehealth was so widely used in the first year of the pandemic, some states are building post-pandemic telehealth policies to retain these expanded benefits.13
Healthcare facility subsidies and waivers
After the expiration of the COVID PHE, hospitals will no longer receive the 20% payment increase for discharges of patients diagnosed with COVID-19.14 In addition, all healthcare facility maintenance programs that were paused will be back in effect.15
The PHE also waived certain requirements that took healthcare workers away from treating patients.16 Rules regarding the following requirements were temporarily suspended or reduced during the PHE but are likely to come back into effect when the PHE ends:17
- The completion of training requirements for some nurses, nurse’s aides, and physician’s assistants if those people are needed to help care for an influx of patients.
- Requirements for creating non-traditional care sites (such as hotels and convention centers) to manage patient overflow.
- Reporting deadlines, audits, and facility maintenance programs.
- The reporting of detailed discharge planning to post-acute care.
- Rules regarding timely updating of physician licensing.
- The requirement that Medicare patients be under the care of a physician.
- The requirement for nursing staff to develop a detailed and evolving nursing care plan for each patient.
- The range of personnel qualified to perform specific respiratory care procedures.
- The requirement of a 3-day prior hospitalization for coverage of a stay in a skilled nursing facility.
- The ability of physicians to request reweighting of performance categories through MIPS Extreme and Uncontrollable Circumstances (EUC) exception.18
Moreover, healthcare providers and volunteer health professionals who benefitted from expanded liability protections regarding COVID treatment, vaccination administration, and emergency care may find those protections are curtailed with the end of the PHE.19
Medicare and Medicaid coverage
While CMS has issued guidance about inappropriately terminating people eligible for expanded medical care coverage under the PHE, it’s estimated that 13% of Medicaid enrollees could lose coverage when it expires. As a result, millions of people may lose coverage or incur higher costs for care.20
How to prepare for the end of the COVID Public Health Emergency
In recent months, many healthcare facilities have attempted a return to “normal” (to the extent that there is a “normal”) and to reinstate pre-pandemic operating requirements. However, the uncertainty of the future and continuing staffing challenges have made it difficult for many healthcare facilities to cope and prepare for the end of the COVID PHE.
Under the circumstances, the promised 60-day warning of the end of the formal PHE may seem all too short. The best coping strategy, however, is planning for the end of the PHE. It may help to:
- Create policies for testing, vaccinating, and treating COVID patients who no longer have insurance coverage.
- Calculate the likelihood of (and prepare for potential) staffing shortages when training waivers expire.
- Inform physicians and other healthcare providers about the potential loss of flexibility and treatment privileges (such as the ability to provide telehealth).
- Review documentation to ensure all materials disseminated are accurate in light of new post-PHE guidelines.
- Check to see if state guidelines provide any post-PHE flexibilities.
The best thing the healthcare industry can do now in order to cope later is to prepare, to the extent possible, for the end of the PHE so that healthcare providers can continue to focus on what they do best: caring for patients.
1 Administration for Strategic Preparedness and Response, “Renewal of Determination That a Public Health Emergency Exists,” July 15, 2022.
2 Centers for Medicare and Medicaid Services, “Coronavirus Waivers & Flexibilities,” May 4, 2022.
3 American Hospital Association, “Hospitals and Health Systems Face Unprecedented Financial Pressures Due to COVID-19,” May 2020.
4 Kaiser Family Foundation (KFF), “What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access,” April 8, 2022.
5 The Commonwealth Fund, “The Risk of Coverage Loss for Medicaid Beneficiaries as the COVID-19 Public Health Emergency Ends,” September 23, 2021.
6 Medicare.gov, “Medicare & Coronavirus,” Accessed August 1, 2022.
7 Kaiser Family Foundation (KFF), “Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends,” January 25, 2021.
8 Centers for Medicare & Medicaid (CMS), “COVID-19 Vaccinations Covered Without Cost-sharing for Eligible Children Aged Six Months to Five Years,” June 22, 2022.
9 Office of Inspector General, “Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic,” March 15, 2022.
10 Medicare Learning Network, “Mental Health Visits via Telecommunications for Rural Health
Clinics & Federally Qualified Health Centers,” June 6, 2022.
11 Centers for Medicare and Medicaid, “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers,” May 24, 2021.
12 Department of Health and Human Services (HHS), “Telehealth Policy Changes After the COVID-19 Public Health Emergency,” August 10, 2022.
13 Pew Charitable Trusts, “Telehealth May Be Here to Stay,” December 1, 2021.
14 American Hospital Association, “Coronavirus Update: CMS Releases Guidance Implementing CARES Act Provisions,” Accessed August 29, 2022.
15 Kaiser Family Foundation (KFF), “Key Issues for State Medicaid Programs When the COVID-19 Public Health Emergency Ends,” January 25, 2021.
16 Centers for Medicare and Medicaid Services (CMS), “Graphic Overview of Flexibilities,” March 3, 2020.
17 Centers for Medicare and Medicaid Services (CMS), “COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers,” March 30, 2020.
18 Centers for Medicare and Medicaid Services (CMS), “About Quality Payment Program (QPP) Exceptions,” August 2, 2022.
19 American Medical Association, “Liability Protections for Health Care Professionals During COVID-19,” April 8, 2020.
20 Kaiser Family Foundation (KFF), “Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey,” March 16, 2022.