March 14, 2023

The End is Near

The End is Near Clinical Services

At the end of January, it was announced that the Biden Administration is planning to end the public health emergency (PHE) on May 11, 2023. That means healthcare organizations have approximately 100 days to prepare for waivers to be eliminated and for changes to policies and practices that gave providers the flexibility they needed during the PHE. At the time of this release PHE will end in less than two months, so providers must begin preparing. While we can’t list them all, let’s look at some of the PHE flexibilities that will change after May 11.

  • One of the most significant changes for skilled nursing facilities (SNFs) throughout the pandemic was the waived three-day prior hospital stay requirement for Medicare beneficiaries who needed to be transferred due to the effects of the pandemic. Also, after a patient exhausted SNF benefits, SNF Medicare coverage could be renewed without having to start a new benefit period. Both flexibilities will expire at the end of the PHE.
  • Group and individual health plans were required to cover COVID-19 tests and vaccines without cost sharing or prior authorization.. These requirements will end with the PHE, although many Americans will continue to pay nothing out of pocket for COVID-19 vaccines. Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are a preventive health service and will therefore be fully covered. Medicare Part B will continue to fully cover COVID vaccines, and Medicaid will provide vaccinations without a co-pay through September 30, 2024. After that date, Medicaid will still cover most ACIP-recommended vaccines for most beneficiaries.
  • HHS waived potential penalties for providers that violated HIPAA by serving patients via SKYPE or FaceTime during the PHE. This will end on May 11.
  • Since April 4, 2022, Medicare has offered beneficiaries free over-the-counter COVID-19 tests. This program will end at the end of the PHE. Medicare beneficiaries enrolled in Part B, however, will still have coverage for physician-ordered laboratory COVID-19 tests with no cost sharing.
  • During the PHE, Medicaid state agencies could not disenroll anyone from Medicaid unless specifically requested (excluding anyone who moved out of state or died). This allowed many people to stay covered without interruption during the pandemic. Timelines have been issued to the states to begin the redetermination process for all Medicaid residents between February and April of this year. Be on the lookout for these notices.
  • States will also begin annual Medicaid eligibility reviews for all enrollees after the PHE ends. Some fear that people who are still eligible may lose their coverage or experience gaps in coverage as a result of the renewal process. Given the large volume of paperwork and staffing shortages, these eligibility reviews will be a challenge for states.
  • During the pandemic, CMS stopped calculating the readmission measure for the SNF value-based purchasing (VBP) program, which is used for scoring and payment adjustments. As a result, all facilities received an identical incentive payment multiplier, and they did not receive an achievement or improvement score or rank. CMS will resume calculating the SNF readmission measure and adjusting payments in FY 2024 or beginning October 1, 2023.

Not all pandemic-related policies will end on May 11, however. The below policies are scheduled to continue beyond the PHE:

  • Effective May 8, 2020, SNFs were required to report COVID-related infections and deaths of both staff members and residents. This initiative is scheduled to continue through December 2024.
  • During the pandemic we saw an expansion in telehealth services to diagnose, evaluate, and treat mental health disorders. This service will continue after the PHE ends, as it has become very important to Americans affected by COVID-19.
  • During the pandemic, Medicare beneficiaries in any geographic location — not just those in rural areas — could receive telehealth services. This flexibility will continue through December 31, 2024.
  • Legislation signed in late December 2022 extends the Acute Hospital Care at Home waiver through December 31, 2024.

CMS hopes that with the end of the PHE and various waivers, providers can return to normal operations and slowly eliminate various pandemic-related flexibilities that are no longer considered critical. Providers should consider how the end of the PHE will affect their operations and start preparing for the upcoming changes.