On May 11, the public health emergency (PHE) expired following three years of flexibility and changes within the healthcare system. So, what has changed for providers and patients?
Cost-Sharing of COVID-19 Vaccines & Treatments
Testing
During the PHE, the federal government purchased all coronavirus vaccines and laboratory tests to allow greater access to these treatments. Upon the expiration of the PHE, health plans, including Medicare Advantage plans, will be permitted to require cost-sharing for these services. Medicare will continue to cover these tests, as it does for all clinical diagnostic testing, if they are ordered by a provider.
Vaccines
The federal government has purchased 1.2 billion doses of Pfizer and Moderna vaccines. Until the federally purchased doses are exhausted, COVID vaccines will continue to be free of cost to all. Once this supply has diminished, vaccines will be transitioned to the traditional health market. The Centers for Medicare & Medicaid Services (CMS) expect to set payment rates for the administration of the vaccine to align with other Part B vaccines. Beneficiaries with private health insurance will likely continue to have the vaccine covered as part of the CDC Vaccine Guidance. The CMS has established a bridge access program for uninsured patients to continue to have access to vaccines.
Telehealth Flexibilities Are Largely Unchanged
Telehealth Continues Through 2024
Telehealth has expanded exponentially since the beginning of the pandemic in 2020. In fact, the Centers for Medicare & Medicaid Services (CMS) has indicated in rulemaking that it is considering which flexibilities will become permanent following the PHE. The Consolidated Appropriations Act of 2023 extended most telehealth flexibilities until December 31, 2024. This extension includes:
- Geographic flexibility, allowing patients to receive care anywhere rather than a designated rural or clinic setting;
- Continuation of evaluation and management (E/M) visits;
- Continuation of audio-only visits; and
- Continuation of expanded qualifying providers (g. physical therapists, occupational therapists and speech pathologists).
What May Require Additional Policymaking
Current regulations and statutes allow for reimbursement for telehealth visits (both audio-visual and audio-only) to ensure parity payment after December 31, 2023. The ACR expects to see more on this issue in the upcoming Medicare Physician Fee Schedule.
HIPAA-Compliance of Platforms Now Required
Upon the expiration of the PHE, all telehealth visits must be performed via a HIPAA-compliant platform. During the initial stages of the pandemic, the Department of Health & Human Services Office of Civil Rights (OCR) used enforcement desecration on HIPAA violations for telehealth platforms, which allowed visits to occur over commercial platforms, such as FaceTime and Zoom. Now, however, all telehealth visits must occur on HIPAA-compliant platforms. The OCR has indicated it will resume enforcement related to the use of any non-compliant platforms.
