How Extensions to the COVID-19 Public Health Emergency Affect Healthcare Reimbursement

June 28th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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On April 12, 2022, the Secretary of Health and Human Services (HHS), Xavier Becerra, announced the extension of the public health emergency (PHE) related to the Coronavirus Disease 2019 (COVID-19) pandemic. Section 319 of the Public Health Service Act gives the federal HHS Secretary the authority to make such a declaration when a severe disease or disorder either becomes, or looks to become, a serious public threat to citizens of the United States.  

This marks the ninth renewal of the PHE, which has occurred every 90 days since January 27, 2020, when originally declared by former HHS Secretary, Alex Azar, under the direction of the Trump Administration. Pursuant to PHEs remain in effect for periods of 90 days, unless the HHS Secretary either renews or officially terminates it before official period ends. 

Additionally, in January 2021, President Biden announced his commitment to provide at least a 60-day notice to all the governors, of any intention to terminate the federal PHE, and currently, no such notice has been given. With the federal PHE declaration, certain authorities were instituted, which provided flexibilities and funding not otherwise available. Those specific to healthcare funding include: 

  • Social Security Act (Section 1135) Waivers: This section of the Act waives certain rules specific to the functionality and funding of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Some of these waivers apply specifically to the performance and reporting guidelines associated with telehealth encounters, audio-only health encounters, and more. 

While these changes have been beneficial in many ways for providers and patients, after such a long period of time working under these waivers, it will be difficult for all to simply return to the pre-pandemic way of doing things when the PHE is officially declared over.

  • The Families First Coronavirus Relief Act: Signed into law in March 2020, this Act provided for a temporary increase in the funding provided to state Medicaid programs, including how states handled eligibility and re-eligibility requirements in order to qualify for the additional funding. 

At the end of the pandemic, there is a significant threat of termination of Medicaid eligibility of millions who were granted such coverage because of the PHE waivers. 

  • Omnibus Appropriations Bill (2022): Created several extensions for telehealth and audio-only healthcare services, which have undergone significant tweaking to facilitate safe patient care through online apps and phone services. 

This bill will allow these liberating telehealth and audio-only guidelines to continue for a period of roughly five months after the end of the federal PHE. 

Over the past year we have seen many states move away from their declared state emergencies, with less than half continuing with emergency declarations specific to COVID-19. 

However, the federal government continues to talk about the PHE as if it will be on-going for an extended period of time, especially if there is even a possibility of the virus continuing to mutate or worsen. Understanding how the PHE affects healthcare programs like Medicaid and Medicare is vital to identifying and reporting proper risk adjustment diagnoses while adhering to the coding and billing guidelines for services like telehealth and audio-only encounters as well as identifying which encounters are eligible for risk adjustment reporting. Begin discussions now to address how these programs and waivers, once terminated, will affect your providers and payer organizations to make a smooth transition back to the pre-pandemic state of healthcare.

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