Lawmakers and regulators worked quickly to increase flexibilities for healthcare providers and impose requirements on health insurers during the COVID-19 pandemic, but several of those important changes are tied to the length of the HHS secretary's public health emergency declaration.
The current public health emergency determination expires in July, but HHS can choose to renew it for another 90 days. HHS already renewed it once in April. The American Hospital Association wrote to HHS on Friday pleading for an extension this summer until testing and medical supply production is higher.
"We anticipate the challenges associated with COVID-19 that our members and communities face every day will continue throughout several months, and potentially another entire year if we continue to experience increased COVID-19 cases," AHA President and CEO Rick Pollack wrote.
Here's a rundown of important coronavirus era changes with bottom-line impact that are tied to the formal public health emergency declaration.
COVID-19 inpatient add-on payment
Congress' third COVID-19 relief legislative package, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, gave hospitals a 20% Medicare add-on payment for inpatient coronavirus cases. That add-on payment would expire with the public health emergency.
However, the suspension of the Medicare sequester passed in the same bill would persist until December 31 regardless of whether the public health emergency continues through that period. The expanded Medicare accelerated and advance payments were supposed to be connected to the public health emergency by statute, but CMS suspended the programs early.
Medicaid matching funds
States are eligible for a 6.2% boost in Medicaid matching funds from the federal government due to the Families First Coronavirus Response Act, but the hike only applies during the public health emergency. The matching funds come with strings attached that impose continuous coverage requirements and restrict state Medicaid programs from tightening eligibility criteria or raising premiums. Those protections also expire with the public health emergency.
In New York, the state budget is designed so cuts to Medicaid can be delayed until the public health emergency expires to ensure the changes don't disqualify the state for federal funds.
Coverage for COVID-19 testing
The Families First Coronavirus Response Act required insurers to cover medically appropriate COVID-19 testing without patient cost-sharing, but the mandate only lasts through the duration of the public health emergency.
The CARES Act relaxed several telehealth restrictions including geographic site restrictions for telehealth reimbursement, and allowed Rural Health Clinics and Federally Qualified Health Centers to be reimbursed for telehealth visits, but those reimbursement policies will end with the public health emergency determination. Lawmakers are debating making some changes permanent, but it's unclear which ones may stick.
Section 1135 waivers
Waivers that CMS has granted states allow flexibilities including bypassing some prior authorization requirements, temporarily enrolling out-of-state providers, delivering care in alternative settings, and pausing fair hearing requests and appeal times would expire with the public health emergency. The waivers are only valid if both a public health emergency and a wider national emergency declaration are in place.