News: CMS releases fact sheet for transition forward from COVID-19 public health emergency

CDI Strategies - Volume 17, Issue 9

The public health emergency (PHE) for COVID-19 will end on May 11, 2023, and CMS recently released a fact sheet covering what organizations and citizens can expect during the transition period in regards to vaccines, testing, and treatments, telehealth services, and healthcare access. During the PHE, healthcare providers received maximum flexibility to better streamline delivery and access to care, and while some of these changes will be permanent or extended, some waivers and flexibilities will expire.

In regards to vaccines, Medicare patients can expect to access COVID-19 vaccinations without cost after the PHE expires, while COVID tests will be at no cost when ordered by certain healthcare providers but may not always be covered over-the-counter depending on the plan. For those with Medicaid and CHIP plans, coverage will provide vaccinations, testing, and treatments without cost until September 20, 2024. For the 18 states and United States territories that have provided Medicaid coverage to uninsured individuals for vaccinations, testing and treatment, this coverage will end on May 11 as well.

Most private health insurance plans must continue to cover vaccines without cost sharing, unless an out-of-network provider vaccinates the person, while mandatory coverage of over-the-counter and laboratory-based COVID-19 PCR and antigen tests will end.

In regards to telehealth, coverage for those with Medicaid, CHIP, and private health insurance will vary according to their plan and the state they reside in. People with Medicare have had broad access to telehealth services without geographic or location limits that usually apply. This was due to a result of waivers during the PHE, some of which will be extended through December 31, 2024, such as:

  • People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
  • People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a healthcare facility.
  • Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer.

For healthcare providers, there are a few high interest items that will affect them whenthe PHE expires. This includes health and safety requirement waivers, the continuous enrollment conditions for Medicaid patients, and the waiver of the requirement that a certified registered nurse anesthetists be under the supervision of a physician—all of which were in place during the PHE but will now expire with it. The flexibility CMS gave when temporarily changing the definition of “direct supervision” to allow supervising healthcare professionals to be virtually present instead of physically will also expire, though on December 31, 2023.

CMS has provided numerous provider-specific fact sheets for information in regards to which PHE waivers and flexibilities have already been terminated, have been made permanent, or will end on May 11. More guidance from CMS is expected as the PHE expiration date draws nearer.

Editor’s note: To read the referenced CMS fact sheet, click here. To access the list of provider fact sheets from CMS, click here.

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