One day prior to the third anniversary of the start of the COVID-19 public health emergency, the Biden Administration announced the PHE will end May 11, 2023. With a few exceptions, all regulatory flexibilities afforded providers during the pandemic will terminate on that date. Having previously been promised 60 days’ notice prior to termination, providers now have 100 days to develop and execute on their return-to-normal plans.
Let’s start with the exceptions: thanks to the Consolidated Appropriations Act, 2023, expanded Medicare reimbursement for telehealth services will extend through December 31, 2024. This includes:
- Continuation of waiver of geographic and location requirements
- Continuation of reimbursement for telehealth services furnished by physical therapists, occupational therapists, speech language pathologists, and audiologists
- Continuation of reimbursement for audio-only services
- Continuation of reimbursement for telehealth services furnished by federally qualified health centers and rural health clinics
- Continuation of use of telehealth to recertify eligibility for hospice
- Delayed implementation of the in-person visit requirement for initiation of tele-behavioral health services
However, there remain several outstanding issues to be addressed by the regulatory agencies:
- Will the expanded list of telehealth services remain in effect through the end of 2024?
- Will CMS continue to pay for telehealth services at the higher non-facility rate?
- Will CMS continue to permit the use of telehealth for direct supervision?
- Will CMS continue to reimburse certain hospital outpatient department services furnished via telehealth?
- Will the Office of Civil Rights and the Office of Inspector General revoke their respective notices of enforcement discretion relating to telehealth?
Separate and apart from Medicare reimbursement, the federal Controlled Substances Act authorizes the use of telehealth during a PHE to complete the required in-person medical evaluation prior to prescribing any controlled substance. Unless Congress acts, this flexibility will terminate on May 11, meaning a practitioner will have to conduct a face-to-face encounter with the patient prior to writing a prescription for a controlled substance after that May 11 termination date.
The Consolidated Appropriations Act also extends the Medicare Acute Hospital Care at Home Program through the end of next year. As of January 17, 2023, 260 hospitals in 37 states have been approved for the program. If your organization had been considering participation but assumed it was too late to get started, now may be the time to pursue this opportunity. (For a detailed discussion of the hospital at home model, view our February 2022 webinar on the subject.)
Other than telehealth and hospital-at-home, the end is growing near. On February 1, CMS updated its previously published fact sheets for specific provider types identifying applicable waivers and flexibilities:
- Physicians and Other Clinicians
- Hospitals and Critical Access Hospitals, Ambulatory Surgery Centers, and Community Mental Health Centers
- Teaching Hospitals, Teaching Physicians, and Medical Residents
- Long-Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
- Home Health Agencies
- Hospice
- Inpatient Rehabilitation Facilities
- Long-Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
- Rural Health Clinics and Federally Qualified Health Centers
- Laboratories
- Medicare Shared Savings Program
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
- Medicare Advantage and Part D Plans
- Ambulances
- End-Stage Renal Disease Facilities
- Participants in the Medicare Diabetes Prevention Program
The roadmap and relevant fact sheet are excellent reference tools as providers fine-tune their return-to-normal plans. However, there are some practical issues CMS will need to address – hopefully soon. For example, if a patient is admitted to a skilled nursing facility prior to May 11 without a qualifying three-day hospital (as this requirement has been waived for the duration of the PHE), will Medicare reimburse the SNF for that admission if it extends beyond May 11?
After three years, the extraordinary tends to become ordinary. The numerous waivers approved to ease the administrative burden during the pandemic have, in many cases, become standard operating procedure. Consider this partial list of flexibilities from which hospitals have benefitted during the PHE:
- Authentication of verbal orders within 48 hours
- Reporting requirements relating to the death of ICU patients with soft wrist restraints
- Information sharing on post-acute providers during hospital discharge planning
- Form and content of medical records, record retention requirements, and deadlines for completion of records
- Providing information to patients on advance directive policies
- Utilization review and QAPI requirements
- Maintenance of nursing plan of care for each patient
- Updates to the therapeutic diet manual
- Medical staff credentialing and privileges process
- CRNA supervision requirements
- Responsibilities of physicians in CAHs (physically present to provide medical direction)
The clock is now ticking to reinstate processes that fully comply with regulatory requirements. Consider this 100-day notice the grace period the government will afford providers to re-train staff and unravel revised processes. After that, it’s business as usual.
If you would like assistance with waivers for telehealth and virtual services; hospital capacity issues; or with any matter involving compliance, valuation, or strategy and integration, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.
