The federal COVID-19 public health emergency will expire Thursday after temporarily transforming the healthcare ecosystem by offering providers, insurers and others unprecedented regulatory flexibility and support to ease their burdens during the outbreak.
With new cases, hospitalizations and deaths on the decline and the World Health Organization declaring the disease is no longer a global emergency, healthcare leaders say the industry is well-positioned to move forward.
The American Hospital Association, Federation of American Hospitals and American Health Care Association, which represents nursing homes, have seen positive results from a number of flexibilities and would like some to continue. The AHA is advocating for telehealth and hospital-at-home extensions to be made permanent, while the AHCA supports an end to the skilled nursing facility three-day requirement for example.
Although it has been more than three months since President Joe Biden's administration announced the end date of the public health emergency, it could be difficult for some providers to transition, said Scot Hasselman, co-chair of law firm Reed Smith’s global life sciences health industry group.
The pandemic tested innovations including telehealth, hospital-at-home, physical infrastructure changes and novel medical devices, all of which provided federal agencies with data on what works. While some flexibilities are ending and others are continuing, leaders see a silver lining in the lessons learned during the public health emergency.
“We're going to see this sort of rapid evolution of how care is delivered," said Jacob Harper, partner in the healthcare group at law firm Morgan Lewis.
Here are the policies the federal government has ended or temporarily extended.
A 20% bump in Medicare payments to hospitals treating COVID-19 patients is ending.
Congress extended Medicare telehealth flexibilities through next year. The program will cover telehealth services for patients anywhere in the U.S., not just in rural areas or healthcare facilities. Some Medicare Advantage plans are offering additional telehealth services. After the policy expires at the end of 2024, some accountable care organizations will allow primary care doctors to use telehealth to remotely treat patients.
Congress extended the Acute Hospital Care at Home program through 2024, so hospitals will continue receiving waivers and reimbursements for hospital at home.
COVID-19 tests and treatments
Health insurance companies are no longer required to provide no-cost COVID-19 tests. Medicaid will continue to cover vaccines, tests and treatments through September 2024. The federal government has purchased vaccines and treatments that will continue to be available until supplies run out. Medicare will continue covering vaccinations without cost sharing, but beneficiaries may face out-of-pocket expenses for treatments.
Waivers that expanded the scope of practice for non-physicians are ending. Certified registered nurse anesthetists can no longer work without physician supervision, although states can apply to continue the policy.
Stark law waivers
Providers will no longer be able to bypass certain self-referral rules and must comply with all Stark law requirements. The Stark Law, formally known as the Physician Self-Referral Law, bars hospitals from billing Medicare for services referred by providers with whom they have financial ties, unless an exception applies.
Medical records must be completed when patients are discharged. During the pandemic, the Centers for Medicare and Medicaid Services waived some discharge planning requirements to accommodate larger patient volumes.
Physical environment flexibilities
Providers will continue to be able to provide direct supervision via telehealth until the end of the year, rather than being physically present.
Skilled nursing facility three-day waiver
Medicare will reinstate the rule requiring a three-day hospital stay before it will cover skilled nursing services. During the pandemic, beneficiaries could be admitted directly to nursing homes.
Nurse aide training
Temporary nurse aides will have four months from the end of the public health emergency to earn their Certified Nursing Assistant certifications. Although CMS ended the training waiver last year, state and local governments had through Thursday to clear training backlogs, which persist in some locations.
The Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration issued a regulation Tuesday to allow digital health companies to continue prescribing controlled substances via telehealth without requiring in-person visits through Nov. 11.
HIPAA penalty waivers
The Health and Human Services Department Office for Civil Rights will resume enforcing penalties on providers that violate the Health Insurance Portability and Accountability Act of 1996. Telehealth providers have until Aug. 9 to comply.