Easing the transition when the COVID-19 public health emergency expires

With the federal public health emergency for COVID-19 (PHE) set to expire May 11, the Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet to help ease the transition.

“The emergency declarations, legislative actions by Congress, and regulatory actions across government, including by the Centers for Medicare & Medicaid Services, allowed for changes to many aspects of health care delivery during the COVID-19 PHE,” notes a statement from CMS. “Health care providers received maximum flexibility to streamline delivery and allow access to care during the PHE. While some of these changes will be permanent or extended due to Congressional action, some waivers and flexibilities will expire, as they were intended to respond to the rapidly evolving pandemic, not to permanently replace standing rules.”

The fact sheet covers the following:

• COVID-19 vaccines, testing, and treatments
• Telehealth services
• Health care access and continuing flexibilities for health care professionals
• Inpatient hospital care at home

Transition plan highlights

• People with Medicare coverage will continue to have access to COVID-19 vaccines without cost sharing after the end of the PHE, according to CMS. They also will be able to continue receiving COVID-19 PCR and antigen tests with no cost sharing when the test is ordered by a physician, physician assistant or registered nurse. Additionally, there will be no change in Medicare coverage of treatments for people exposed to COVID-19 once the PHE ends.
• As outlined by the American Rescue Plan Act of 2021, states must provide Medicaid and CHIP coverage without cost sharing for COVID-19 vaccinations, testing, and treatments through the last day of the first calendar quarter that begins one year after the last day of the COVID-19 PHE. If the COVID-19 PHE ends, as expected, on May 11, this coverage requirement will end on September 30, 2024. Additionally, 18 states and U.S. territories have opted to provide Medicaid coverage to uninsured individuals for COVID-19 vaccinations, testing, and treatment, according to CMS.
• The Consolidated Appropriations Act of 2023 extended many telehealth flexibilities through December 31, 2024. For example, people with Medicare can access telehealth services anywhere in the United States rather than only in rural areas, and certain telehealth visits can be audio-only if someone is unable to use both audio and video.
• For Medicaid and CHIP, telehealth flexibilities are not tied to the end of the PHE and have been offered by many state Medicaid programs long before the pandemic. Coverage will ultimately vary by state, according to CMS.
• Under the Consolidated Appropriations Act of 2023, the Acute Hospital Care at Home initiative has been extended through December 31, 2024, according to CMS. Hospitals can continue to apply to participate in the initiative. If an individual is receiving care in a participating hospital and meets the requirements to receive inpatient care at home, they can continue to do so.

Read more: Employers need to revisit coverage as end of COVID emergency approaches

Additionally, CMS has created a series of provider-specific fact sheets for details about how health care providers and suppliers should prepare for the end of the COVID-19 PHE.