Resources for the Approaching End of the COVID-19 Public Health Emergency

Sarah Hohman, Director of Government Affairs

The Biden Administration will be officially ending the COVID-19 Public Health Emergency (PHE) on May 11, 2023. The PHE has been renewed approximately every 90-days since January 27, 2020.

At the onset of the PHE, many waivers and flexibilities were granted across the health care industry to reduce administrative burden, increase access to care, and more. Since then, many of the flexibilities have been granted permanent coverage, or given a timeline separate from the PHE. This article will ensure you’re up to date on what is ending on May 11th, and what flexibilities will remain. Various CMS resources can be found below.

RHC Specific Waivers

The conclusion of the PHE will end the below waivers:

• Certain Staffing Requirements. 42 CFR 491.8(a)(6).
  • During the PHE, CMS waived the requirement that a NP, PA, or CNM be available to furnish patient care services at least 50% of the time the RHC is operating.
• Temporary Expansion Locations. 42 CFR §491.5(a)(3)(iii).
  • During the PHE, CMS waived the requirement that RHCs be separately considered for Medicare survey and certification if services were expanded into more than one permanent location, including areas that would not typically meet RHC location requirements. Upon termination of the PHE, these expanded locations will be subject to location requirements and separate survey and certification.
• Bed Count for Provider-Based RHCs
  • During the PHE, CMS permitted provider-based RHCs subject to their clinic-specific, grandfathered upper-payment limit to increase their hospital bed count over 50 without losing their grandfathered status. At the conclusion of the PHE, grandfathered RHCs must lower their bed count to 50 or less or lose their grandfathered payment status.

   

• Home Nursing Visits
  • During the PHE, CMS removed the requirement that RHCs in an area without a current home health area shortage needed a written request and justification in order to provide home nursing services.

• Virtual Communication Services
  • During the PHE, CMS allowed for online digital evaluation and management services (99421, 99422, and 99423) to be reimbursed under G0071. After the PHE, G0071 should only be used for G2012 and G2010. This was one of the first telecommunications flexibilities granted to RHCs during COVID, but the passing of the CARES Act allowed many more services to be done via telehealth during the PHE and beyond.

Additionally, while some Medicare telehealth policies were extended past the PHE (read more below), the enforcement discretion that allows telehealth services to be provided through non-HIPAA-secure communications technology will end with the PHE, and providers will have 60 days to get into compliance. The HIPAA privacy rule will not prevent providers from offering covered audio-only telehealth services, however.

Other waivers ending at the conclusion of the PHE are the 20% hospital payment increase for treatment of patients with COVID-19, as well as numerous blanket waivers in place for healthcare providers broadly, including Stark Law waivers.

RHC Waivers With Different Timelines

• Physician Supervision of NPs in RHCs and FQHCs. 42 CFR 491.8(b)(1).
  • During the PHE, CMS waived the requirement that physicians provide medical direction for the RHCs’ nurse practitioners, to the extent permitted by state law. Note: the RHC Burden Reduction Act recently introduced in the Senate would make this permanent for both NPs and PAs if passed. Learn more here. This waiver will end on December 31, 2023.

Telehealth

While originally linked to the PHE, many Medicare telehealth flexibilities will remain past May 11th, including RHCs ability to serve as distant site providers through December 31, 2024. As a reminder, mental health services provided via telehealth are permanently covered, and paid the RHC All-Inclusive Rate, although the occasional in-person requirement has also been delayed through December 31, 2024. Medical telehealth services should continue to be billed G2025 and will be reimbursed at $98.27 in 2023. Please visit NARHC.org for more details on RHC telehealth.

The Drug Enforcement Agency has announced that they will temporarily keep the flexibility for providers to prescribe certain drugs without an initial in-person visit. The DEA will eventually release a final policy on this, but it is unclear at this time how long the extension will last.

Ongoing Access to COVID-19 Supplies/Products

The HRSA RHC COVID-19 Supply Programs that offer free, direct access to COVID-19 vaccines, therapeutics, and testing supplies are also not tied to the PHE. For more details on enrollment and what remains available, please visit NARHC.org.

If enrolled in this program, please continue to update inventory weekly on HPOP and contact RHCcovidsupplies@narhc.org with any questions.

CMS COVID-19 Health Care Staff Vaccination Mandate

The White House announced in May 2023 that various COVID-19 vaccine mandates would be ending soon. However, until the official end date is announced, all RHCs must continue to comply with the mandate.

CMS Resources

• FAQs on the end of the PHE
• PHE Fact Sheet
• Guidance for Surveyors
• OTC Test Coverage by Payor

The COVID-19 PHE has lasted over three years and has impacted the healthcare industry in significant ways that will remain long after the official declaration has expired. With any questions on these provisions or the PHE coming to an end, please contact Sarah Hohman, NARHC Director of Government Affairs, at Sarah.Hohman@narhc.org.