The COVID-19 pandemic may not be over, but—after nearly three and a half years—the federal public health emergency is finally over. The healthcare system will have a lot of adjustments to make.
President Joe Biden has announced that he will not renew the declaration, which gives the government broad but temporary powers to ease the impact of the coronavirus pandemic on healthcare providers. , individuals, health insurance companies and states, on Monday. The Biden administration last extended the state of emergency on January 11, and it will expire on May 11.
The public health emergency has been in place since President Donald Trump first activated it in January 2020. Along with the declaration of a broader national emergency, the Department of Health and Human Services and its constituent agencies were able to waive or relax many health care regulations to mitigate the public health emergency. financial blow to the health care system and the patients it serves and to facilitate access to testing, immunization, and treatment.
When the public health emergency ends, these flexibility will end. The Centers for Medicare and Medicaid Services began withdrawing some exemptions last year, such as those related to nursing home operations and telehealth. Other pandemic rule changes could be extended or made permanent, through regulation or legislation.
But without new policymaking, here are the key federal policies that will disappear when the declaration of a public health emergency expires in four months:
Higher reimbursement for COVID-19 hospitalizations: Hospitals are now receiving a 20% increase in Medicare reimbursement for inpatient hospitalizations due to COVID-19, related to the public health emergency. But an additional payment to provide new COVID-19 treatments has been extended until the end of fiscal year 2023.
Telehealth: Congress and Biden have extended some telehealth flexibility through 2024, but not every pandemic-related policy has been incorporated into law. For example, Medicare now pays for telehealth visits the same way as in-person visits, a provision that will be scrapped at the end of the year because lawmakers haven’t extended it. However, more than 30 states have adopted payment parity rules, and Congress is considering continuing to implement the current reimbursement policy for two years.
Hospital at home: CMS has enabled hospitals to provide acute care to off-site beneficiaries. The program has proven popular, with more than 90 health systems in 34 states participating. Congress extended the Home Hospital Acute Care initiative to 2024 last month, allowing hospitals to continue to receive home hospital waivers and reimbursements.
Redefining Medicaid: States had a 6.2% increase in their Federal Medicaid matching rates due to the pandemic but were not allowed to remove enrollees from the program provided additional funds were available, even if they are no longer eligible for coverage. Once the public health emergency declaration ends, states will be free to continue to redefine Medicaid eligibility. HHS predicts that 15 million people will lose benefits. States have 14 months to cancel Medicaid enrollment for those who are not eligible starting April 1. Insurers are preparing to convert Medicaid members to other forms of coverage, such as other forms of coverage. like subsidized health insurance exchange policies.
Coverage for COVID-19 testing and treatment: During a public health emergency, most private health insurance plans cover COVID-19 tests with no cost sharing. Private insurers and Medicare also pay for up to eight COVID-19 home tests per enrollee per month. Medicaid must cover vaccines, treatments, and tests for more than a year after the public health emergency ends. Separately, HHS is offering Eli Lilly’s Bebtelovimab, a monoclonal antibody treatment, at no cost to uninsured patients until supplies run out, scheduled for this fall.
Workforce: During a public health emergency, CMS gives employees more flexibility. Anesthesiologists can work without a doctor’s supervision, and practicing nurses can also do so in some settings. Non-physicians are also authorized to supervise diagnostic tests. Physicians whose privileges have expired at hospitals or ambulatory surgery centers or who have not been fully approved may continue to practice at the hospital to assist with associated workforce shortages. regarding COVID-19. CMS also allows virtual monitoring of residents.
Exemptions from strict laws: Doctors were able to bypass some self-referral rules during a public health emergency to ensure access to care for Medicare and Medicaid beneficiaries.
Drain planning: CMS has waived some discharge planning requirements for hospitals.
Other administrative tasks: CMS has allowed hospitals considerable flexibility when it comes to administrative tasks during a public health emergency. The agency allows for more use of verbal commands, extends medical records completion times, and waives usage review requirements, among other things.
Flexibility of the physical environment: Hospitals have been allowed to use alternative patient care locations, as long as those locations are approved by the states in which they operate.
A three-day waiver in a skilled nursing facility: Typically, Medicare beneficiaries need to stay in the hospital for three days before Medicare covers a nursing home stay. CMS has waived this requirement during a public health emergency.
Medicare Complaints: During a public health emergency, Medicare contractors and independent review organizations may allow provider extensions to file appeals of reviewer decisions.
Prescribing a controlled substance: The Drug Enforcement Administration allows registered providers to prescribe controlled substances through telehealth in an emergency without first in-person assessment of the patient, which has increase accessibility in rural areas.
Waiver of HIPAA penalty: HHS used enforcement discretion to waive sanctions against hospitals that failed to comply with certain requirements of the Health Insurance Portability and Accountability Act, such as patient’s right to confidential communications.
Emergency use authorization: The Food and Drug Administration is not required to lift temporary approvals for vaccines, pharmaceuticals, and medical devices used in COVID-19 patients when it declares a public health emergency. contract expires.
Lauren Berryman contributed to this story.
