On January 30, 2023, the Biden Administration announced its plans to end the national emergency and Public Health Emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. These emergency declarations, in place since early 2020, have given the federal government the flexibility to modify requirements in various areas, including health insurance programs, medical countermeasures, and reimbursement policies.

Although the below is not an exhaustive list of all the COVID-19 related federal policy and regulatory provisions, some major flexibilities tied to the PHE include:

Telehealth Expansion

During the PHE, the following flexibilities were granted to expand telehealth access to patients:

  • Medicare beneficiaries in any geographic area can receive telehealth services, rather than beneficiaries living in rural areas only
  • Beneficiaries can remain in their homes for telehealth visits reimbursed by Medicare, rather than needing to travel to a health care facility
  • Telehealth visits can be delivered via smartphone in lieu of equipment with both audio and video capability. HHS has waived potential penalties for HIPAA violations against providers using this flexibility in good faith during the PHE.
  • An expanded list of Medicare-covered services which can be provided via telehealth

The passage of the Consolidated Appropriations Act (CAA) of 2023 provided an additional extension to preserve telehealth flexibilities until December 31st, 2024.

For more details, CMS maintains a complete list of coronavirus waivers and flexibilities that have been exercised since early 2020 here: https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf

COVID-19 Reimbursement

In an attempt to provide financial support for expanded costs of care for treating patients, the Centers for Medicare and Medicaid (CMS) took action to increase reimbursement during the active PHE.  For example:

  • Hospitals receive a 20% increase in the Medicare payment rate through the hospital inpatient prospective payment system
  • CPT 99072 was created for non-facility providers to report additional supplies and staff time due to a public health emergency
  • Payment for telehealth services have been made in parity with face-to-face services

These actions, with the exception of the telehealth reimbursement, which was expanded with the CAA, will end with the expiration of the PHE in May.

The end of the COVID-19 emergency declarations and related legislative provisions will mark a significant milestone in the country’s efforts to overcome the pandemic. Advocate encourages providers to review any flexibilities utilized during the PHE and plan for the upcoming expiration of the declaration.

As always, ADVOCATE will keep you up to date on this and all issues impacting medical groups as they become available.

Kayley Jaquet

Manager, Regulatory Affairs