The end of the public health emergency: Action items for health plan sponsors
As the COVID emergency ends on May 11, the Departments of Health and Human Services, Labor and Treasury have issued guidance for employers with regard to COVID vaccine and test costs, telehealth and mental health parity.
The light at the end of the tunnel for the COVID-19 pandemic is getting brighter by the day. The COVID-19 National Emergency and Public Health Emergency are scheduled to end on May 11.
“It’s been a long three years,” said Mary Powell, a director of the West Coast law firm Trucker Huss. “It seems like a hundred years ago when this whole thing started. We know that during the National Health Emergency period and the Public Health Emergency period the government issued billions of pages of guidance for us — but that’s all coming to an end.”
Powell participated in “End of the COVID-19 National and Public Health Emergencies — Action Items for Health Plan Sponsors,” an April 20 webinar sponsored by her firm. Her colleague Alaina Harwood, an associate at Trucker Huss, discussed guidance from the Departments of Labor; Health and Human Services; and Treasury about how the end of the emergency will affect health plans in several key areas.
Related: The end of the COVID emergency: DOL offers guidance for employer health plans
Testing. After the end of the Public Health Emergency, health plans no longer will be required to cover COVID-19 tests and testing-related services for free. They may impose cost sharing, prior authorization or other medical management requirements for such services.
“Plan sponsors will need to decide whether to keep the benefit as is (there is no requirement to reduce the benefit); amend health plans to cease providing any coverage for COVID-19 tests; or amend the plan so it continues to offer coverage for COVID-19 but imposes requirements on this testing, such as cost sharing,” she said.
If the benefit is removed or reduced, the plan must notify participants. If the plan does remove the benefit, the plan sponsor should consider communicating with participants that COVID-19 tests purchased by an individual may be reimbursed though the individual’s FSA, HRA or HSA, as applicable.
Vaccines. Non-grandfathered plans still will be required to cover in-network COVID-19 vaccines without cost sharing as part of the Affordable Care Act preventive services mandate that applies indefinitely for certain in-network immunizations. If a non-grandfathered plan does not have a service provider in its network that provides vaccines, it must cover vaccines provided by out-of-network provider without cost sharing.
Plan sponsors of non-grandfathered plans will need to decide whether to:
- Keep the plan benefit as is — there is no requirement to reduce the benefit;
- Amend the plan to cover in-network COVID-19 vaccines without cost sharing after the end of emergency; or
- Amend the plan to continue covering both in-network and out-of-network vaccines but to apply cost sharing for out-of-network vaccines.
Standalone telehealth. “Large employers can offer standalone telehealth benefits to employees who are not enrolled in the employer’s major medical coverage,” Harwood said. “This provides relief from many of the ACA market reform rules. A plan sponsor will need to determine if this is a benefit offered to employees and if a change is needed for the next plan year.”
Mental health parity. The agencies said they will not take any enforcement action against a plan that disregards benefits for COVID-19 testing items and services that are required to be covered without cost sharing for purposes of testing. The relief appears to end when the emergency ends, because at that time, plans are no longer required to cover COVID-19 testing with no cost sharing.
“A plan sponsor should review how the plan’s mental health parity tests were performed and determine if the change will impact that testing,” she said.
Employee Assistance Programs. An EAP will not be considered to provide benefits that are significant in the nature of medical care solely because it offers benefits for COVID-19 diagnosis and testing during emergencies. In addition, the EAP will not be considered to provide significant benefits solely because it offers benefits for COVID-19 vaccines and their administration.
Related: The COVID public health emergency is ending, but is America safe?
“If the employer adds COVID-19 diagnosis, testing and/or vaccine benefits to the EAP, evaluate whether those rise to the level of significant medical care to preserve the excepted benefit state of the EAP,” she said. “Remember, the removal of the benefit may trigger a notice requirement to participants.”
Of course, employers are free to exceed federal guidelines to continue offering many of the benefits that they did during the pandemic.
“I seriously hope you will consider keeping as many of these benefits as you can,” Powell said. “I think they have provided great value. None of these things were too crazy — they were just a way to expand benefits. I have heard from employers who talked to their actuaries that keeping a lot of these benefits is only about a 1% or 1-1/2% cost increase. It’s worth considering the value of these benefits, the increased cost and what you should keep.”