A number of pandemic-era policies tied to the federal public health emergency will soon expire on May 11, affecting providers, payers and others in the industry that have relied on some of those flexibilities over the past few years.
Waivers concerning health system operations and care access amid the pandemic, like those concerning excess hospital capacity amid surges of COVID-19 cases, will end, according to a statement from the HHS. Healthcare providers will no longer be able to prescribe controlled substances via telehealth without an in-person visit. And private insurance companies will no longer be required to cover COVID-19 tests without cost sharing.
“We are in a better place in our response than we were three years ago, and we can transition away from the emergency phase,” the agency said in the statement, noting that since the peak of the omicron surge at the end of January 2022, daily reported COVID-19 cases are down 92%, and deaths and hospitalizations have both declined by about 80%.
What won’t change
Major telehealth flexibilities will continue for Medicare enrollees and will remain in place through December 2024 under the Continuing Appropriations Act. They will also continue for Medicaid enrollees, and states already have flexibility in covering and paying for those services delivered virtually.
Access to emergency use authorizations for new COVID-19 tests, treatments and vaccines through the Food and Drug Administration will also continue.
The government allowed patients to start buprenorphine used to treat opioid use disorder by telehealth without a required in-person visit first, and that will continue even as the PHE ends. Access to expanded methadone take-home doses will also not be impacted.
The HHS said it is committed to ensuring wide access of COVID-19 vaccines and treatments to whoever needs them, even as the funds for free vaccines and treatment have run out. Most private insurance plans will cover vaccines without a co-pay though, according to the agency. Vaccines are covered under Medicare Part B without cost sharing which will continue, and Medicaid will cover all vaccines without a co-pay or cost sharing through September 2024.
What will change
A pandemic-era policy originally tied to the PHE barring states from kicking Medicaid enrollees off the rolls during the public health crisis will now end April 1 under the Continuing Appropriations Act. That policy helped spur major enrollment growth, though about 15 million people are expected to lose coverage as a result of redeterminations over the next two years, the HHS predicts.
The CMS used emergency authority waivers, regulations and sub-regulatory guidance to ensure healthcare providers could still operate effectively and patients could seek care throughout the pandemic, though those will end once the PHE expires.
“States, hospitals, nursing homes, and others are currently operating under hundreds of these waivers that affect care delivery and payment and that are integrated into patient care and provider systems,” the HHS said. Many of the flexibility are related to facility capacity and are no longer needed as major surges of COVID-19 cases have waved, it said.
Some Medicaid waivers will end on May 11 while others will remain in place for six months after the PHE ends. Many flexibilities like those supporting home and community-based services are available for states to continue past the PHE.
COVID-19 surveillance data will change, as the agency will no longer be able to require test reporting data from labs. The HHS is encouraging states to continue sharing vaccine administration data, and hospital data reporting will continue through 2024, though may be reduced from current daily reporting.