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.
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.
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 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.
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.
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.
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