Although most medical practices have become accustomed to the COVID-19 Public Health Emergency (PHE) being continually extended, it was clear that eventually would end—and now it seems that time will arrive. The Biden Administration announced last week that the PHE will be extended through May 11, at which point it will permanently expire, marking the end of PHE extensions. Because the PHE has been in place for nearly three years, it can be difficult to remember which rules existed before then, and which have been temporary.
To get a sneak peek into what is expected to change when the end of PHE extensions arrives in May, check out a few highlights.
Changes to COVID-19 Vaccine Coverage
Because the government was underwriting the cost of COVID-19 vaccination administration, patients had more flexibility on getting free shots during the PHE. For instance, if you were uninsured or saw an out-of-network provider, you still got a free COVID shot. That will no longer be the case.
Patients will be covered for these vaccines under their own health insurance programs, which all have their own rules about who patients can see and how frequently they can get vaccinated. For instance, patients may need to see an in-network doctor to be covered for a COVID-19 vaccination under their insurance, and many uninsured patients will have to pay out of pocket if they come in seeking vaccinations.
Best practice: Prepare now by getting COVID-19 coverage requirements from all your major payers in writing, and provide your front desk with verbiage to use when explaining why COVID-19 vaccines are no longer free for uninsured or out-of-network patients.
Some Patients Will Lose Medicaid Coverage
During the PHE, Medicaid payers weren’t allowed to disenroll patients from the program, but that’s about to end. Estimates say up to 15 million people will be removed from the Medicaid program when the PHE ends, which could create ripple effects as these patients find themselves uninsured.
Because of this, the government will be opening a special enrollment period allowing patients who no longer qualify for Medicaid to apply for Affordable Care Act coverage outside of the normal enrollment period. This special enrollment will start March 31, so if your practice sees patients concerned about losing Medicaid benefits this spring, it’s a good idea to let them know about ACA openings.
Best practice: Boost your pre-authorization efforts so you know ahead of time if a patient has lost Medicaid coverage. If you see this happen, contact the patient before their appointment to let them know their options, and be ready to provide any patient who may be losing insurance coverage with the ACA enrollment web address and let them know about the special enrollment period.
COVID-19 Tests No Longer Free
Under the PHE, patients were able to obtain COVID-19 tests, both for at-home use and at doctors’ offices, at no charge. Medicare is expected to stop paying for at-home tests, and to only cover medical testing when the tests are ordered by a provider after the end of PHE extensions in May. Depending on insurer coverage of tests performed at your office, you may start seeing more patients presenting for COVID-19 tests since they can’t test at home for free anymore.
Best practice: Evaluate how your major payers are planning to reimburse in-office COVID-19 tests, and if you don’t have one, develop a protocol for how and where you’ll perform such tests at the office.
What Won’t Change: Medicare Telehealth Flexibilities
Practices can rest assured that the Medicare telehealth flexibilities won’t stop when the PHE ends in May. When Congress passed the Consolidated Appropriations Act of 2023, it extended most of the telehealth flexibility waivers through December 31, 2024. This means you have more than a year to continue utilizing telehealth as you have been with your Medicare patients.
Best practice: When it comes to Medicaid patients, the telehealth coverage rules will vary by state, so be sure to gather each Medicaid insurer’s telehealth guidelines. You should also check with private payers about their telehealth coverage plans and regulations.
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