Based on current COVID-19 trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023.
As the COVID-19 pandemic continues to evolve, healthcare providers have had to navigate rapidly changing policies and guidelines from various regulatory bodies, including the Centers for Medicare and Medicaid Services (CMS). With the end of the COVID-19 public health emergency in sight, CMS has begun to announce changes to policies that will affect healthcare providers in the coming months.
At the same time, CMS has also announced some permanent changes to telehealth policies. For example, CMS has proposed that certain telehealth services be added to the list of Medicare-covered services permanently. These include telehealth services for mental health and substance use disorders, as well as certain virtual check-ins and remote evaluation services.
Covid 19 testing, treatments, and vaccines:
For Medicare:
- After the end of the public health emergency (PHE), individuals who have Medicare coverage will still be able to receive COVID-19 vaccinations without incurring any cost-sharing fees.
- Medicare does not typically cover over-the-counter (OTC) services and tests according to regulations. The provision of free OTC COVID-19 tests will end once the PHE concludes. Nonetheless, some Medicare Advantage plans might offer coverage as a supplementary benefit.
- Medicare Advantage plans will cover both tests and treatments; however, cost-sharing fees might be subject to change after PHE ends.
- There will be no alterations to Medicare coverage for treatments for individuals who were exposed to COVID-19 once the PHE has ended. Deductibles and cost-sharing fees that are currently in effect will continue to be enforced. Access to oral antivirals, for the most part, will not be impacted by the end of the COVID-19 PHE.
For Medicaid & CHIP:
- The American Rescue Plan Act of 2021 (ARPA) has established that Medicaid and CHIP will provide coverage for COVID-19 vaccination, testing, and treatment, without imposing any cost-sharing.
- Medicaid and CHIP will provide coverage for COVID-19 vaccination, testing, and treatment until the end of the first calendar quarter, which begins one year following the conclusion of the COVID-19 PHE. Assuming that the COVID-19 PHE ends as planned on May 11, 2023, this coverage requirement will conclude on September 30, 2024.
- After the expiration of the coverage requirements established by the ARPA, Medicaid and CHIP coverage for COVID-19 treatment and testing may vary on a state-by-state basis.
For Commercial Insurances:
- Private health insurance plans must continue to cover COVID-19 vaccinations provided by in-network healthcare providers without any cost-sharing requirements for the majority of policies. However, if an out-of-network provider administers the vaccine, individuals with private health insurance may be required to cover a portion of the costs.
- Following the expected conclusion of the PHE on May 11, 2023, compulsory coverage for over-the-counter and laboratory-based COVID-19 PCR and antigen tests will terminate. Nonetheless, coverage for these items or services will vary depending on the private health insurance plan. If private insurance covers these items or services, it may require cost-sharing, prior authorization, or other types of medical management.
- The conclusion of the PHE will not alter how treatments are covered by private health insurance plans. Deductibles and cost-sharing fees that are currently in effect will continue to be enforced.
Telehealth Services:
For Medicare:
- The Consolidated Appropriations Act of 2023 has extended telehealth flexibilities and waivers through December 31, 2024. These extensions include:
Medicare beneficiaries can now receive telehealth services in any location within the United States, not just those in rural areas, providing greater access to care for individuals across the country. - Medicare beneficiaries can now receive telehealth services from the comfort of their own homes rather than traveling to a healthcare facility, which can be particularly helpful for those who have mobility issues or live in remote areas.
- Certain telehealth visits can be provided through audio-only means, such as a telephone, for individuals who are unable to use both audio and video technologies, such as a smartphone or computer.
- Medicare Advantage plans may provide additional benefits, depending on the specific insurance plan. This can include coverage for telehealth services that are not typically covered under traditional Medicare, such as virtual physical therapy or mental health counseling.
For Medicaid & CHIP:
- Unlike Medicare, telehealth flexibilities for Medicaid and CHIP are not linked to the end of the PHE and have been available through many state Medicaid programs well before the pandemic. Coverage for these services may differ depending on the state.
- CMS encourages states to maintain coverage for Medicaid and CHIP services when they are provided via telehealth. This is crucial to ensure that individuals who may have difficulty accessing in-person healthcare services continue to receive necessary medical care through telehealth, particularly in rural or underserved areas.
For Commercial Insurances:
- Following the end of the PHE, reimbursement policies for telehealth and other remote care services offered by commercial payers will likely vary, similar to the current situation. This could include cost-sharing and prior authorization requirements for these services, depending on the specific policies of the commercial payer.
- It is recommended that individuals review their specific health insurance plan to understand their coverage and any associated costs or requirements for telehealth and other remote care services.
At the end of the PHE, three federal requirements that were previously waived are expected to be reinstated immediately. These requirements include:
- The requirement for an in-person visit before a telehealth appointment. This means that patients will need to have an in-person evaluation with a healthcare provider before they can schedule a telehealth visit.
- The requirement for healthcare providers to have a federal DEA (Drug Enforcement Administration) registration in the state where the patient is located during the telehealth appointment. This requirement ensures that healthcare providers comply with state and federal laws when prescribing controlled substances via telehealth.
- The requirement for telemedicine services is to be conducted through a HIPAA-compliant platform. This is to ensure that patient information remains secure and confidential during telehealth visits.
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