As of May 11th, 2023, the Public Health Emergency declaration for the COVID-19 pandemic has ended. Thus ending many different programs, reporting requirements, and flexibilities as the healthcare industry folds COVID response activities into sustainable public health practices.
The biggest impact from the end of the PHE will be the discontinuation of the Medicaid Continuous Enrollment. This will trigger CT DSS to take steps to redetermine eligibility of a significant number of HUSKY enrollees. Health center patients will no doubt be impacted and CHCACT is working diligently with Access Health and health center enrollment staff to support this process.
CHCACT is also supporting health center staff with other changes that will take place as a result of the PHE ending. There will be changes affecting all departments of health center operations. CHCACT is working closely with all workgroups to provide up-to-date information on the immediate and phased changes. This page will be updated as information becomes available.
For RHCs and FQHCs, COVID-19 vaccines and their administration are paid the same way as influenza and pneumococcal vaccines and their administration.
That is, COVID-19 vaccines and their administration are paid at 100 percent of reasonable cost through the cost report. CMS will continue to pay this way after the PHE ends.
We are modifying the requirement at 42 CFR 491.8(b)(1) that physicians must provide medical direction for the clinic’s or center’s health care activities and consultation for, and medical supervision of, the health care staff, only with respect to medical supervision of nurse practitioners and only to the extent permitted by state law.
The physician, either in person or through telehealth and other remote communications, continues to be responsible for providing medical direction for the clinic or center’s health care activities and consultation for the health care staff, and medical supervision of the remaining health care staff.
This allows RHCs and FQHCs to use nurse practitioners to the fullest extent possible and allows physicians to direct their time to more critical tasks. This flexibility is currently set to return to pre-PHE requirements at the end of the calendar year that the PHE ends.
During the PHE, CMS allowed practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment while continuing to bill from their currently enrolled location.
When the PHE ends, the waiver will continue through December 31, 2023.
Section 3704 of the CARES Act authorized RHCs and FQHCs to furnish distant site telehealth services to Medicare beneficiaries during the COVID-19 PHE.
Medicare telehealth services generally require an interactive audio and video telecommunications system that permits real-time communication between the practitioner and the patient. (Some telehealth services can be furnished using audio-only technology.) RHCs and FQHCs with this capability could provide and be paid for telehealth services furnished to Medicare patients located at any site, including the patient’s home, through December 31, 2024.
Telehealth services could be furnished by any health care practitioner working for the 4 02/24/2023 RHC or the FQHC within their scope of practice. Practitioners could furnish telehealth services from any distant site location, including their home, during the time that they are working for the RHC or FQHC, and could furnish any telehealth service that is included on the list of Medicare telehealth services under the Physician Fee Schedule (PFS), including those that have been added on an interim basis during the PHE.
A list of these services, including which could be furnished via audio-only technology, is available at https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.
Beginning March 1, 2020, and for the duration of the COVID-19 PHE, virtual communication services have been expanded to include online digital evaluation and management services, which are non-face-to-face, patient-initiated, digital communications using a secure patient portal.
The payment rate for the virtual communication services HCPCS code (G0071) reflects the online digital evaluation and management CPT codes (99421, 99422, and 99423) in addition to HCPCS codes for virtual communication services (G2012 and G2010). Therefore, payment for HCPCS code G0071 is set at the average of the national non-facility PFS payment rates for these five codes. All virtual communication services would also be available to new patients that had not been seen in the RHC or FQHC within the previous 12 months.
Additionally, in situations where obtaining prior beneficiary consent would interfere with the timely provision of these services, or the timely provision of the monthly care management services, consent could be obtained when the services are furnished instead of prior to the service being furnished, but must be obtained before the services are billed.
We also have allowed patient consent to be acquired by staff under the general supervision of the RHC or FQHC practitioner for the virtual communication and monthly care management codes.
When the COVID-19 PHE ends, the payment for virtual communication services (G0071) will no longer include online digital evaluation and management services and these services may only be provided to established patients. Additionally, consent for services will require direct supervision.
RHCs and FQHCs have been able to provide visiting nursing services to a beneficiary’s home with fewer requirements, making it easier for beneficiaries to get care from their home.
- Any area typically served by the RHC and any area included in the FQHC’s service area plan has been determined to have a shortage of home health agencies, and a request for this determination has not been required;
- Any RHC/FQHC visiting nurse service solely to obtain a nasal or throat culture has not been considered a nursing service because it does not require the skills of a nurse to obtain the culture, as the specimen could have been obtained by an appropriately-trained medical assistant or laboratory technician; and
- The revised definition of “homebound” would have applied to patients receiving visiting nursing services from RHCs and FQHCs. Once the COVID-19 PHE ends, RHCs and FQHCs, located in an area that has not been determined to have a current HHA shortage and seeking to provide visiting nurse services will have to make a written request along with written justification that the area it serves meets the required conditions and that the definition of “homebound” will not apply to patients receiving visiting nursing services from RHCs and FQHCs.
CMS has been waiving the requirement in the second sentence of 42 CFR §491.8(a)(6) that a nurse practitioner, physician assistant, or certified nurse-midwife be available to furnish patient care services at least 50% of the time the RHC and FQHC operates.
CMS is not waiving the first sentence of §491.8(a)(6), which requires a physician, nurse practitioner, physician assistant, certified nurse midwife, clinical social worker, or clinical psychologist to be available to furnish patient care services at all times the clinic or center operates.
This will assist in addressing potential staffing shortages by increasing flexibility regarding staffing mixes during the PHE. This waiver will terminate at the end of the COVID-19 PHE.
During the PHE, CMS has been allowing Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) in the FFS program (42 CFR 405.942 and 42 CFR 405.962) and MA and Part D plans, as well as the Part C and Part D Independent Review Entity (IREs) (42 CFR 422.582 and 42 CFR 423.582), to allow extensions to file an appeal. Specifically, 42 CFR 422.582(c) and 42 CFR 423.582(c) allow a Part C or Part D plan to extend the timeframe for filing a request if there is good cause for the late filing.
In addition, the Part D IRE may find good cause for the late filing of a request for reconsideration. When the COVID-19 PHE ends, these flexibilities will continue to apply consistent with existing authority, and requests for appeals must meet the existing regulatory requirements.
Providers that continue to experience the impacts of the PHE and require additional time to file their cost report may submit a request to their MAC in accordance with our regulation at 42 CFR 413.24 (f)(2)(ii).
The MAC has the authority to grant up to a 60-day extension of the due date for filing a cost report if the provider’s operations are significantly adversely affected due to extraordinary circumstances over which the provider has no control, such as the PHE.
To allow more people to receive care during the PHE, CMS temporarily changed the definition of “direct supervision” to allow the supervising health care professional to be immediately available through virtual presence using real-time audio/video technology instead of requiring their physical presence.
CMS also clarified that the temporary exception to allow immediate availability for direct supervision through virtual presence also facilitates the provision of telehealth services by clinical staff “incident to” the professional services of physicians and other practitioners.
This flexibility will expire on December 31, 2023.
CMS has been waiving the requirements at 42 CFR §491.5(a)(3)(iii), which require RHCs and FQHCs to be independently considered for Medicare approval if services are furnished in more than one permanent location.
Due to the current PHE, CMS has temporarily waived this requirement, removing the location restrictions to allow flexibility for existing RHCs/FQHCs to expand service locations to meet the needs of Medicare beneficiaries. This flexibility includes areas that may be outside of the location requirements, at 42 CFR § 491.5(a)(1) and (2), for the duration of the PHE. CMS will end this waiver at the conclusion of the PHE.
All facilities are required to fit test their staff for N95 masks on an annual basis; and as needed for special circumstances.
Health Centers were able to provide COVID-19-related services to non-established patients and were still covered for malpractice liability under the FTCA. No clear end date for this flexibility.
Coverage for COVID-19-Related Activities by Health Center
The provision of grant-supported health services by individuals who have been deemed as Public Health Service employees through the Health Center FTCA Program and the Health Center Volunteer Health Professional (VHP) FTCA Program, and who provide grant-supported health services to prevent, prepare or respond to COVID-19 to individuals who are established patients of the health center, whether at the health center or offsite, and whether in person or through telehealth, benefits patients of these entities and general populations that could be served by these entities through community-wide intervention efforts within the communities served by such entities, and therefore is eligible for liability protections for the provision of such services under section 42 U.S.C. § 233(g)-(n) and (q).
U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announces that the Notifications of Enforcement Discretion issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act during the COVID-19 public health emergency will expire at 11:59 pm on May 11, 2023, due to the expiration of the COVID-19 public health emergency.
“OCR exercised HIPAA enforcement discretion throughout the COVID-19 public health emergency to support the health care sector and the public in responding to this pandemic,” said Melanie Fontes Rainer, OCR Director. “OCR is continuing to support the use of telehealth after the public health emergency by providing a transition period for health care providers to make any changes to their operations that are needed to provide telehealth in a private and secure manner in compliance with the HIPAA Rules.”
In 2020 and 2021, OCR published four Notifications of Enforcement Discretion in the Federal Register regarding how the Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”) would be applied to certain violations during the COVID-19 nationwide public health emergency. These Notifications and the effective beginning and end dates are:
- Enforcement Discretion Regarding COVID-19 Community-Based Testing Sites During the COVID-19 Nationwide Public Health Emergency – PDF, effective from March 13, 2020, to 11:59 pm May 11, 2023.
- Enforcement Discretion for Telehealth Remote Communications During the COVID–19 Nationwide Public Health Emergency – PDF (“Telehealth Notification”), effective from March 17, 2020, to 11:59 pm May 11, 2023.
- Enforcement Discretion Under HIPAA To Allow Uses and Disclosures of Protected Health Information by Business Associates for Public Health and Health Oversight Activities in Response to COVID-19 – PDF, effective from April 7, 2020, to 11:59 pm May 11, 2023.
- Enforcement Discretion Regarding Online or Web-Based Scheduling Applications for the Scheduling of Individual Appointments for COVID-19 Vaccination During the COVID-19 Nationwide Public Health Emergency – PDF, effective from December 11, 2020, to 11:59 pm May 11, 2023.
OCR is providing a 90-calendar day transition period for covered health care providers to come into compliance with the HIPAA Rules with respect to their provision of telehealth.
The transition period will be in effect beginning on May 12, 2023 and will expire at 11:59 p.m. on August 9, 2023. OCR will continue to exercise its enforcement discretion and will not impose penalties on covered health care providers for noncompliance with the HIPAA Rules that occurs in connection with the good faith provision of telehealth during the 90-calendar day transition period.
As a result of the American Rescue Plan Act of 2021 (ARPA), 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, 2023, this coverage requirement will end on September 30, 2024.
After that date, many Medicaid and CHIP enrollees will continue to have coverage for COVID-19 vaccinations. After the ARPA coverage requirements expire, Medicaid and CHIP coverage of COVID-19 treatments and testing may vary by state.
Additionally, 18 states and U.S. territories have opted to provide Medicaid coverage to uninsured individuals for COVID-19 vaccinations, testing, and treatment. Under federal law, Medicaid coverage of COVID-19 vaccinations, testing, and treatment for this group will end when the PHE ends.
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. CMS encourages states to continue to cover Medicaid and CHIP services when they are delivered via telehealth.
The continuous enrollment condition for individuals enrolled in Medicaid is no longer linked to the end of the PHE. Under the Families First Coronavirus Response Act, states claiming a temporary 6.2 percentage point increase in the Federal Medical Assistance Percentage (FMAP) have been unable to terminate enrollment for most individuals enrolled in Medicaid as of March 18, 2020, as a condition of receiving the temporary FMAP increase.
As part of the Consolidated Appropriations Act, 2023,the continuous enrollment condition will end on March 31, 2023. The temporary FMAP increase will be gradually reduced and phased down beginning April 1, 2023 (and will end on December 31, 2023). For more information, visit Medicaid.gov/unwinding.