The End of the COVID-19 Public Health Emergency: What Are the Implications for Your Practice?

On January 30, 2023, President Biden announced that the public health emergency (PHE) will expire on May 11, 2023,¹ a decision that is certain to have a significant impact on both patients and providers. It is anticipated that the unwinding of the PHE will be a challenging endeavor, and understandably, there are numerous topics that require consideration and discussion, including the termination of specific policies, the future of telehealth services for Medicare beneficiaries, changes in Medicaid enrollment guidelines, and the removal of cost waivers for COVID-19 testing. Providers need to review the impact of these upcoming changes, in addition to any others that bear weight on the financial stability of their practices or the ability of patients to access the care they need.

Critical Policies and Expiration Dates

I have compiled a list of critical policies and expiration dates to help practices understand the types of changes on the horizon (see Table).² It is important to keep in mind that this is not an exhaustive list and it is possible that future legislation may further extend some of these provisions.

Medicare and Telehealth

Notably, legislation to protect Medicare beneficiaries’ access to telehealth services was passed before the expiration date of the PHE was announced. A press release by the US Department of Health & Human Services stated the following:

“The vast majority of current Medicare telehealth flexibilities that Americans—particularly those in rural areas and others who struggle to find access to care—have come to rely upon over the past two years, will remain in place through December 2024 due to the bipartisan Consolidated Appropriations Act, 2023 passed by Congress in December 2022.”³

It has been a long journey to secure widespread telehealth approval for Medicare beneficiaries, regardless of the originating site. This most recent Consolidated Appropriations Act could indicate that Medicare is considering making this change permanent, but those conversations are just beginning. Pending any final legislation, policies implemented in practice should be considered temporary allowances.

Medicaid Changes

During the PHE, several changes were implemented to promote access to care for patients, and several of these were directed at Medicaid. The Centers for Medicare & Medicaid Services has established a guide for states to use for evaluating ongoing reimbursement for telehealth services.⁴

Federal matching dollars that were tied to increased patient access will expire on March 31, 2023.⁵ However, other changes (eg, which telehealth services will be reimbursed, reverification of beneficiary eligibility, etc) are being left for individual states to interpret, based on what they determine is the best course of action for their residents.

To learn more about the changes taking place in your state, refer to your state’s Medicaid website. If you are not sure where to start, go to Medicaid.gov for more information.

Removal of Cost-Sharing Waivers

As noted in the Table, the cost-sharing waivers for COVID-19 testing and in-home test supplies are expiring, and the specific expiration dates depend on the payer. For example, cost-sharing waivers for Medicare beneficiaries will expire on May 11, 2023, whereas Medicaid beneficiaries will have until the last day of the first calendar quarter beginning 1 year after the end of the PHE. Commercial plans will formulate their own statements.

I strongly recommend that healthcare leaders be proactive and reach out to payers for updated information and upcoming expiration dates. They should also take the time to review payer notification e-mails and any change remittance advice documents they may receive. These activities will help them prepare and budget for the future, as well as provide their patients with accurate information so they know what to expect going forward.

The COVID-19 PHE will have been in effect for more than 3 years when it finally expires in May, and unwinding the temporary allowances that have been in place for so long will not be easy. Acknowledging the challenges ahead, the US Department of Health & Human Services is offering a variety of fact sheets, toolkits, and other resources on its website to help us along the way.³ Providers and administrators should take the time to review this information and initiate discussions with their teams to facilitate a smoother transition to a post-PHE state of practice.

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References

1. LaFraniere S, Weiland N. U.S. plans to end public health emergency for Covid in May. Updated February 3, 2023. www.nytimes.com/2023/01/30/us/politics/biden-covid-public-health-emergency.html. Accessed February 13, 2023.
2. Cubanski J, Kates J, Tolbert J, et al. What happens when COVID-19 emergency declarations end? Implications for coverage, costs, and access. Updated January 31, 2023. www.kff.org/coronavirus-covid-19/issue-brief/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access/. Accessed February 13, 2023.
3. US Department of Health & Human Services. Fact sheet: COVID-19 public health emergency transition roadmap. February 9, 2023. www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html#:~:text=Based%20on%20current%20COVID%2D19,day%20on%20May%2011%2C%202023. Accessed February 13, 2023.
4. Centers for Medicare & Medicaid Services. April 23, 2020. State Medicaid & CHIP telehealth toolkit: policy considerations for states expanding use of telehealth, COVID-19 version. www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit.pdf. Accessed February 13, 2023.
5. United States Congress. Consolidated Appropriations Act, 2023, H.R. 2617, 117th Congress.