Preparing for the End of the PHE: What Practices Can Do Now

Shawntea (Taya) Moheiser, MBA, CMPE, CMOM
Owner, ITS Healthcare, Omaha, NE

The Public Health Emergency (PHE), which has been in place since January 27, 2020, is going to end, although the official expiration date has not yet been determined. Many of the regulations built into 2022 final rulings from the Centers for Medicare & Medicaid Services (CMS) tied changes to the expiration of the PHE. In addition, there were several expansions of care associated with the PHE under the COVID-19 blanket 1135 waiver, which will also end when the PHE goes away. Practices should begin taking some steps now to prepare for the expiration of the PHE, which can help to ease the transition for patients and staff members.

What We Know So Far

The following provides an overview of the current status of the PHE, as well as some of the significant changes to healthcare delivery that will occur when it expires.

  • Per the US Department of Health and Human Services’ Acting Secretary Norris Cochran’s letter to governors on January 22, 2022, the Biden Administration will give states a 60-day notice before the PHE expires.
  • Some states have finalized policies in place to maintain PHE regulations beyond the federal PHE expiration. This varies by state.
  • It is not yet known how commercial payers will respond post-PHE.
  • In a memorandum released on April 7, 2022, CMS announced that it will terminate several temporary emergency declaration blanket waivers that have provided long-term care and other facilities with flexibilities designed to support the COVID response.1,2
  • Although the PHE expiration date is unknown, CMS’ Quarterly National Stakeholder Call on April 26, 2022, referred to the “unwinding” of the PHE several times, whereas the previous call did not reflect on the need to prepare for a post-PHE industry.3

The sidebar lists some of the provisions that will end when the PHE expires. It is important to remember that this list is not exhaustive—there were many flexibilities put into place over the past 2 years that are now being reviewed, revised, and considered for repeal upon expiration.

It should also be noted that the following provisions will remain in place after the PHE expires:

  • CMS expanded telehealth services for evaluation, treatment, or diagnosis of a mental health disorder.
    • In-person requirements do apply within 6 months of initial visit and every 12 months thereafter.
    • Modifier required for audio-only and request or inability to use video must be the patient’s desire or inability, not the practice’s.
  • Opioid Treatment Programs will be permitted to furnish counseling and therapy services via audio-only after the conclusion of the PHE, provided certain requirements are met, and a service-level modifier is used.

Provisions That Will End When the COVID-19 PHE Expires

  • The 6.2% increase in Medicaid’s Federal Medical Assistance Percentage will expire at the end of the quarter in which the PHE ends.
  • Waiver of originating site/geographic location for telehealth services to Medicare beneficiaries will expire 151 days after the PHE ends. This includes the temporary authority to pay RHCs and FQHCs for furnishing distant site Medicare Telehealth Services.
  • Audio-only telehealth services and expanded qualifying health providers (ie, OTs, PTs, SLPs, and audiologists) will expire 151 days after the PHE ends.
  • Vaccine administration rate of $40 per dose for COVID-19 vaccine will expire after the end of the year in which the PHE ends, at which point the rate will align to other vaccines.
  • Category 3 Telehealth Codes will expire at the end of the 2023 calendar year.
  • RHCs that established “temporary locations” during the PHE with Medicare billing privileges must submit a complete CMS-855 enrollment application or be deactivated.
  • Telehealth Payment Parity from CMS will expire with the PHE.
  • Telehealth Licensure expansion which allowed providers to treat patients in other states in which the provider was not licensed will expire when the PHE ends.
  • The penalty phase of the Appropriate Use Criteria program will now begin January 1, 2023, or the January 1 that follows the end of the PHE.
  • Medicare will resume revalidation processes, audits, and medical reviews when the PHE ends or where there is evidence of potential fraud, waste, or abuse.
  • Most cost-sharing waivers for the testing of COVID-19 will expire post-PHE.

CMS indicates Centers for Medicare & Medicaid Services; FQHCs, federally qualified health centers; OTs, occupational therapists; PHE, public health emergency; PTs, physical therapists; RHCs, rural health clinics; SLPs, speech-language pathologists.

Sources: Centers for Medicare & Medicaid Services. Update to COVID-19 emergency declaration blanket waivers for specific providers. www.cms.gov/files/document/qso-22-15-nh-nltc-lsc.pdf; US Department of Health and Human Services. Public health emergency declarations. www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx; MGMA. Medicare telehealth waivers. www.mgma.com/getmedia/ 474f3b3d-01c2-4e04-beae-446f746328ae/Updated-MGMA-Medicare-Telehealth-Waivers-03-23-2022.pdf.aspx?ext=.pdf.

What Practices Can Do to Prepare

During the PHE, states were under very specific requirements regarding Medicaid programs. For example, they were not allowed to transfer enrollees to more restrictive insurance packages, increase premiums, or create stricter eligibility standards. Each state that met these requirements was granted a 6.2% increase to their regular Federal Medical Assistance Percentage for compliance. This special provision helped states respond effectively to the COVID-19 pandemic, and not surprisingly, contributed to a significant rise in Medicaid enrollees. According to the Kaiser Family Foundation, “After declines in enrollment from 2017 through 2019, preliminary data for January 2022 show that total Medicaid/CHIP enrollment grew to 87.0 million, an increase of 15.7 million from enrollment in February 2020 (22.1%).”4

When the PHE expires, the 6.2% increase that states have been receiving from the federal government will also end. It is expected that many states will begin reigning in their Medicaid programs by adding more eligibility restrictions and increasing rates. This could result in loss of coverage for millions of enrollees. Practices need to be mindful of their patients’ changing insurance and benefits and take steps to update financial hardship programs and assess self-pay schedules to help them continue with high-quality care.

Practice managers also need to review the changing regulations against their current policies and procedures. They should identify how these changes may affect their organization and act now to prepare their staff accordingly. Team members who joined a practice during the pandemic may not be aware of previous workflows and policies. New workflows for telehealth that may seem almost routine now may be shaken up significantly after the PHE expires.5

It is advised that providers and managers take the time to read through the blanket 1135 waiver, the 2022 Final Physician Fee Schedule Rule, newly passed state legislation, and memoranda from specialty societies for guidance. If they have specific questions regarding processes, procedures, protocols, reimbursement, or billing, they should reach out to the appropriate governing bodies directly for more information.

Conclusion

The COVID-19 PHE afforded providers greater flexibility in caring for their patients amid unprecedented circumstances. Now, after more than 2 years, the end of the PHE is on the horizon. This will result in the loss of many flexibilities as well as the start of eligibility redeterminations for Medicaid waivers, which will have a significant impact on providers and patients alike. Now is the time for practices to begin preparing for the return to “normal” operations and to make patients aware of the changes to come, to ensure a smoother transition to post-PHE compliance and the best clinical outcomes.

References

  1. US Department of Health and Human Services. Public health emergency declarations. www.phe.gov/emergency/news/healthactions/phe/Pages/default.aspx. Accessed May 17, 2022.
  2. Centers for Medicare & Medicaid Services. CMS returning to certain pre-COVID-19 policies in long-term care and other facilities. April 7, 2022. www.cms.gov/newsroom/press-releases/cms-returning-certain-pre-covid-19-policies-long-term-care-and-other-facilities. Accessed May 17, 2022.
  3. Centers for Medicare & Medicaid Services. CMS national stakeholder calls. Updated May 11, 2022. www.cms.gov/outreach-education/partner-resources/cms-national-stakeholder-calls. Accessed May 17, 2022.
  4. Corallo B, Moreno S. Analysis of recent national trends in Medicaid and CHIP enrollment. May 2, 2022. www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/#. Accessed May 10, 2022.
  5. Rodriguez S. HHS renews COVID-19 PHE, key flexibilities that come with it. January 18, 2022. https://revcycleintelligence.com/news/hhs-renews-covid-19-phe-key-flexibilities-that-come-with-it. Accessed May 17, 2022.
Article provided through a partnership with
Practice Management Institute
and
Michigan Society of Hematology & Oncology

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