Written and submitted by Capitol Associates, Inc., in partnership with AHRA Regulatory Affairs Committee
On January 30th, the Biden Administration announced that it intends to let the COVID-19 public health emergency (PHE) expire on May 11th. In doing so, the Administration fulfilled its promise to give stakeholders at least 60 days advanced notice before ending the PHE.
The May 11th end date gives the public (and the government) time to prepare for the changes that will occur when the PHE ends. However, over the last two years, Congress has delinked some of the biggest temporary policies and authorities that were initially tied to the PHE. Nevertheless, many of the temporary regulatory flexibilities these agencies instituted during the PHE will immediately end on May 12th and revert back to the pre-pandemic regulations. Hospitals will no longer receive a 20% increase in the Medicare payment for treatment of patients with COVID-19, and many blanket waivers in place for healthcare providers will expire.
While we cannot cover all the temporary emergency policies in this article, we did want to highlight a few policies relevant to radiology. Until July of 2022, the penalty phase of the Appropriate Use Criteria program was to begin on the first of January after the PHE ended. However, as we have covered, CMS indefinitely delayed the start of the penalty phase on there website and thus the end of the PHE no longer has any impact on the AUC program.
The end of the PHE will mean the conclusion of the remote supervision policy wherein direct supervision of imaging and other services could be performed through the virtual presence of the supervising practitioner. However, CMS is not terminating this flexibility on May 12th, instead CMS will continue this policy through the end of the 2023.
There are a few Medicare telehealth coverage policies that will end when the PHE ends, but most of the telehealth policies that began under the PHE have been extended through 2024. The two biggest barriers to telehealth usage pre-pandemic were: 1-the geographic requirements that restricted the telehealth benefit to rural Medicare beneficiaries, and 2-the originating and distant site requirements that prevented patients from being able to receive telehealth services at home. Each of these policies were waived at the start of the PHE, allowing for telehealth to be greatly expanded, but were technically set to kick back in 151 days after the PHE. However, Congress fully delinked these telehealth policies and extended Medicare telehealth coverage through the end of 2024 when they passed the Consolidated Appropriations Act of 2023 (The 2023 Omnibus) in December.
One example of a temporary Medicare telehealth coverage policy that will end immediately after the PHE ends is the waiver that allows telehealth services to be provided through non-HIPAA-secure communication methods. More information is available on the HHS PHE telehealth webpage.
Another policy that was once tied to the PHE but was recently delinked from the PHE is the so-called “Medicaid Redetermination” policy. During the COVID-19 PHE, state Medicaid programs received increased federal Medicaid payments in exchange for not removing Medicaid enrollees from Medicaid coverage even if those enrollees no longer qualified for the program. As a result, there are currently millions of individuals receiving Medicaid coverage who will need to their eligibility for the program “redetermined” by the states. The 2023 Omnibus allows states to begin this redetermination process in April of 2023.
Of particular note for patients, when the PHE expires in May, many of the cost-sharing protections that required insurance to fully cover COVID testing and treatment will expire including the federal requirement that plans must cover COVID-19 vaccines without cost sharing. Ultimately, the end of the PHE on May 11th formally transitions the healthcare industry to post-pandemic policy. COVID-19 has undoubtedly shook up the healthcare industry, and while many of the PHE policy changes are already permanent, or will become permanent, many other pre-pandemic rules will return. We encourage everyone to review the resources we have linked in this article if you want to understand in greater detail all the policy nuances wrapped up with the Public Health Emergency.
Please visit AHRA Advocacy for more information on regulatory issues, legislation, AUC, and more! This information was provided by Nathan Baugh of Capitol Associates, AHRA’s advocacy partner in Washington, DC.