Is the End Really Near?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Feb 7th, 2023

What is going on? We hear rumors that the end is near; well, that depends on what you are talking about; the end of what? The pandemic is not over; we are just making a transition. Covid is still here, and vaccines will still be administered, but it is time for a change. We all understand viruses are constantly changing, and COVID-19 is no exception; it is not the same variant we saw in 2019. We are no longer in a state of emergency! On January 30, 2023, the Biden Administration announced their intentions to end the COVID-19 national emergency and public health emergency (PHE) related to the COVID-19 pandemic on May 11, 2023. In this article, we will spotlight, at a very high level, some of the other adjustments and changes made by the government; this list is not all-inclusive! Be sure to do your homework to determine how this will affect you.

There will be a lot of changes to consider once the emergency declarations have ended. We will see some return to the office, while others have learned to adapt to this new normal and even seen higher productivity and business costs go down.  Federal funding will change dramatically, such as healthcare coverage. During the PHE, tens of millions of Americans were funded by the states to ensure healthcare coverage. Payer policies will change and private payers may no longer fund COVID-19 vaccines, administration, testing, and services related to COVID-19. Some changes are here to stay; for example, the CDC is still promoting COVID-19 vaccinations. Medicaid and other plans have adopted COVID-19 vaccines as a part of their preventive medicine services, and I don’t think this will go away anytime soon. 

So Why Wait?
According to the release of the Statement of Administration Policy, "An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans." Read the entire release for more information. The Administration is supporting an "orderly, predictable wind-down".

How will it Affect Us?

Medicaid

• Medicaid plans to follow the current Advisory Committee on Immunization Practices (ACIP) for recommended vaccines for adults and children. The ACIP currently recommends COVID-19 vaccines and administration without cost-sharing to the patient.
• Uninsured Covid testing under the Medicaid eligibility pathway will end with the Public Health Emergency (PHE).
• Cost sharing for COVID-19 vaccines are no longer required to be covered unless it is a benefit as a preventive service offered by the payer.
• Testing and related services are no longer free.
• Health plans reimburse out-of-network providers for vaccines, tests, and related services.

Fees for Vaccines

According to CMS, "CMS will continue to pay approximately $40 per dose for administering COVID-19 vaccines in outpatient settings for Medicare beneficiaries through the end of the calendar year that the PHE ends. Effective January 1 of the year following the year that the PHE ends, CMS will set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines." Keep an eye out for a final 2023 Physician Fee schedule rule.

Telehealth

• Telehealth allowed services via a smartphone and opened the geographic area to more than just rural communities. The Consolidated Appropriations Act of 2023 extended this through December 31, 2021.
• Medicare beneficiaries seeking mental health and substance abuse support will continue using telemedicine.
• Distant site providers may change. Check with your state; some states are opting to keep them while others may not. 
• Telehealth used to issue prescriptions without a face-to-face evaluation; this will end with the PHE.

Hospitals

Hospitals will no longer be paid a rate increase of 20% for treating covid patients.

Skilled Nursing

The 3-day hospitalization requirement is no longer required for skilled nursing at the end of the PHE. 

Medicare Advantage Plans

• No longer required to supply up to a 90-day supply of covered drugs.
• No longer have to cover out-of-network plans as in-network at a Medicare-participating hospital.

Emergency Use Vaccines

The emergency use of vaccines was deemed safe and effective but not formally approved and will not be terminated. Watch for the HHS Secretary to specify an end date, currently set for October 1, 2024, although there are some exceptions, according to KFF.

One positive we have all learned from this is how to be more flexible! Remember those expensive trips we used to take for important meetings? We have learned ZOOM is a great alternative for expensive meetings.