In The News

What Happens When COVID-19 Emergency Declarations End? Implications for Coverage, Costs, and Access

Kaiser Family Foundation / By Juliette Cubanski et al. 

On Jan. 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. These emergency declarations have been in place since early 2020, and gave the federal government flexibility to waive or modify certain requirements in a range of areas, including in the Medicare, Medicaid, and CHIP programs, and in private health insurance, as well as to allow for the authorization of medical countermeasures and to provide liability immunity to providers who administer services, among other things. In addition, Congress also enacted legislation—including the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security (CARES) Act , the American Rescue Plan Act (ARPA), the Inflation Reduction Act (IRA), and the Consolidated Appropriations Act, 2023 (CAA)—that provided additional flexibilities tied to one or more of these emergency declarations, and as such they too are scheduled to expire when (or at a specified time after) the emergency period(s) expires.

This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, and summarizes the flexibilities triggered by each in the following areas:

This is not meant to be an exhaustive list of all federal policy and regulatory provisions made in response to COVID-19 emergency declarations. For example, we do not cover the entire range of federal and state emergency authorities exercised under Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 waivers; Section 1135 waivers; and 1915 (c) waiver Appendix K strategies. The Centers for Medicare & Medicaid Services maintains a more complete list of coronavirus waivers and flexibilities that have been exercised since early 2020; some state actions to respond to the emergency may have expiration dates that are not tied to the end of the federal emergency declarations. This brief also does not include all congressional actions that have been made affecting access to COVID-19 vaccines, tests, and treatment that are not connected to emergency declarations, such as coverage of COVID-19 vaccines under Medicare and private insurance (see Commercialization of COVID-19 Vaccines, Treatments, and Tests: Implications for Access and Coverage for more discussion of these issues).

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CDC Launches Website to Help Consumers Find Free COVID-19 Testing Sites

Today CDC launched the COVID-19 Testing Locator website, which will allow consumers to search for free COVID-19 testing sites near them. The locator is part of the CDC Increasing Community Access to Testing (ICATT) program, which provides access to COVID-19 testing, focusing on communities at a greater risk of being impacted by the pandemic, people who do not have health insurance, and surge testing in state and local jurisdictions.

Tests offered may include laboratory-based nucleic acid amplification tests (NAATs), including polymerase chain reaction (PCR) tests, and rapid antigen point-of-care (POC) testing. Results are typically provided within 24–48 hours. Testing is available at pharmacies, commercial laboratory sites, community sites, and retail locations.

COVID-19 testing is available at no-cost at ICATT sites to people with or without health insurance who are experiencing symptoms or have been exposed to someone with COVID-19. The tests are billed to third-party payers, such as Medicare, Medicaid, and private health insurers. People without health insurance do not have to pay for COVID-19 testing at ICATT locations. Consumers can access the Testing Locator at testinglocator.cdc.gov.

 

Year-End Funding Package Includes Medicare and Medicaid Policies

Medicare Rights Center / By Lindsey Copeland

In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal year (September 30, 2023) and makes several important changes to Medicare and Medicaid.

Medicare

Medicare Telehealth

PHE Waiver Extension—The bill extends most of the COVID-19 public health emergency (PHE) Medicare telehealth flexibilities through 2024 and directs the Department of Health & Human Services (HHS) to study telehealth utilization and assess potential fraud.

Medicare Mental Health Care

Provider Expansions—Medicare mental health coverage has known gaps, which the spending bill helps close. One long-sought change will allow Medicare Part B to cover services provided by marriage and family therapists and licensed professional counselors beginning January 1, 2024.

Intensive Outpatient Services—To further ease access, the package revises Medicare’s partial hospitalization benefit to establish coverage of intensive outpatient services beginning January 1, 2024.

Crisis Psychotherapy Services—It also increases payments for mobile crisis care (crisis psychotherapy services furnished by a mobile unit or in other non-facility settings) starting on January 1, 2024.

Workforce Development—It provides for 200 new Medicare-supported graduate medical education (GME) residency positions, half of which are allocated for psychiatry and psychiatry subspecialties.

Provider Outreach—To promote uptake, the omnibus requires HHS to educate providers on the availability of crisis psychotherapy services, behavioral health integration services, and opioid use disorder treatment services under Medicare.

COVID Treatments—The bill temporarily (through December 2024) allows Part D plans to cover oral antiviral treatments that have an emergency use authorization (EUA). This update will permit Medicare to cover COVID-19 treatments like Paxlovid once the PHE ends and those products shift to the commercial market.

Medicare Coverage Changes and Extenders

Lymphedema Compression Garments—Under the bill, compression garments for the treatment of lymphedema will be covered under Part B as durable medical equipment (DME) starting in January 2024.

In-home intravenous immune globulin services (IVIG)—It also provides permanent Medicare coverage for items and services related to the administration of IVIG, beginning on January 1, 2024.

Durable Medical Equipment—The omnibus continues the blended payment rates for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in certain non-competitive bid areas through 2023.

Hospital at Home Waiver—It extends (through December 31, 2024) the Acute Hospital Care at Home initiative.

Medicaid

Medicaid Home- and Community-based Services (HCBS)

Money Follows the Person and Spousal Impoverishment—The bill continues the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving HCBS through September 30, 2027. These critical Medicaid policies that we have long supported help older adults and people with disabilities live with choice, dignity, and independence.

Medicaid PHE Coverage

Continuous Coverage Requirement—The omnibus sunsets the Medicaid continuous coverage requirement. Created in 2020 by the Families First Coronavirus Response Act (FFCRA), this provision has allowed states to maintain their Medicaid rolls in exchange for a 6.2% federal match rate (FMAP) bump. The FFCRA tied this coverage policy to the duration of the PHE; it will now end on April 1.

At that time, the enhanced FMAP will begin to reduce gradually, eventually reaching zero on December 31, 2023. The maintenance of effort (MOE) requirements tied to the FMAP increase—that states may not make eligibility standards, methodologies, or procedures for determining Medicaid eligibility more restrictive than they were on January 1, 2020—will continue to apply during the phase-down period.

Medicaid Eligibility and Funding

Enhanced Eligibility Postpartum and for Children—The bill also requires states to give children (under the age of 19) 12 months of continuous coverage in Medicaid and CHIP and permanently extends the American Rescue Plan policy allowing states to provide 12 months of postpartum coverage to pregnant individuals in Medicaid and CHIP.

Funding for the U.S. Territories—The omnibus extends Puerto Rico’s higher federal Medicaid match (76%) through September 30, 2027, and permanently extends a higher federal match (83%) for American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin Islands. These updates will provide much-needed consistency and fiscal stability.

 

US Health Officials Propose Annual COVID-19 Vaccination for Most Americans

Associated Press
 
WASHINGTON — U.S. health officials want to make COVID-19 vaccinations more like the annual flu shot.

The Food and Drug Administration on Monday proposed a simplified approach for future vaccination efforts, allowing most adults and children to get a once-a-year shot to protect against the mutating virus.
 
This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster.
 
The proposal comes as boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August.
 
The FDA will ask its panel of outside vaccine experts to weigh in at a meeting Thursday. The agency is expected to take their advice into consideration while deciding future vaccine requirements for manufacturers.
 
In documents posted online, FDA scientists say many Americans now have “sufficient preexisting immunity” against the coronavirus because of vaccination, infection or a combination of the two. That baseline of protection should be enough to move to an annual booster against the latest strains in circulation and make COVID-19 vaccinations more like the yearly flu shot, according to the agency.
 
For adults with weakened immune systems and very small children, a two-dose combination may be needed for protection. FDA scientists and vaccine companies would study vaccination, infection rates and other data to decide who should receive a single shot versus a two-dose series.
 
FDA will also ask its panel to vote on whether all vaccines should target the same strains. That step would be needed to make the shots interchangeable, doing away with the current complicated system of primary vaccinations and boosters.
 
The initial shots from Pfizer and Moderna — called the primary series — target the strain of the virus that first emerged in 2020 and quickly swept across the world. The updated boosters launched last fall were also tweaked to target omicron relatives that had been dominant.
 
Under FDA's proposal, the agency, independent experts and manufacturers would decide annually on which strains to target by the early summer, allowing several months to produce and launch updated shots before the fall. That’s roughly the same approach long used to select the strains for the annual flu shot.
 
Ultimately, FDA officials say moving to an annual schedule would make it easier to promote future vaccination campaigns, which could ultimately boost vaccination rates nationwide.

The original two-dose COVID shots have offered strong protection against severe disease and death no matter the variant, but protection against mild infection wanes. Experts continue to debate whether the latest round of boosters significantly enhanced protection, particularly for younger, healthy Americans.

 

What's Ahead for Health IT Policy and Legislation in 2023

Healthcare IT News / By Andrea Fox
 
With Congress providing telehealth waivers as part of its omnibus spending bill at the close of 2022, delaying the "telehealth cliff" for two years, HIMSS says it's now ready to make the case for permanent reimbursement of virtual care.
 
Also on its policy agenda for the year ahead: advocating for data standardization, offering input for interoperability rulemaking and engaging with agencies and states to increase telehealth access. We spoke with the HIMSS government relations team for their thoughts on those priorities and more in 2023 and beyond.
 
Making telehealth's case for cost control
 
Telehealth has proven to reduce burdens on healthcare providers and improve access and has been a priority for HIMSS for many years, but the Congressional Budget Office has long complained that all of the data has been for non-Medicare patients, explained Tom Leary, senior vice president and head of government relations at HIMSS, parent company of Healthcare IT News.
 
Budget leaders have asked, "How do you really know what the impact on the Medicare population and the Medicare Trust Fund will be? We now have three years of data on the impact to the Medicare Trust Fund," he said.
 
While the pandemic-era telehealth waivers answered many questions at the federal level, the two-year extension to offer telehealth in high-deductible health plans with health savings accounts included in the final legislative package of 2022 has opened a new window to pursue making the changes permanent. 
 
HIMSS will "use the next two years to gather additional data to inform both Congress and CBO on either the cost of avoidance or the cost control aspects," said Leary.
 
In addition to making telehealth coverage permanent, simplifying access for patients is another goal for the mission-driven non-profit, whose goal is to reform the global health ecosystem through the power of information and technology

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