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In January 2020, the Secretary of the Department of Health and Human Services (HHS) declared a public health emergency (PHE) in response to the COVID-19 pandemic. Three years later, the Secretary announced that the PHE would be allowed to expire on May 11, 2023. Although the announcement was expected, concerns remain among healthcare providers.

Purpose of the PHE

When the Secretary declares a PHE, he or she has broad authority to suspend or revise regulations, enter into contracts, and detail HHS employees to help meet the emergency. The COVID-19 PHE suspended various training requirements, suspended personal visit requirements for physicians and other providers, allowed telehealth visits, and made vaccines and treatments widely available. As you may imagine, with three years of fewer regulatory requirements and streamlined processes, healthcare providers aren’t looking forward to going back to a more heavily regulated system.

Key Provisions of the PHE for Nursing Homes

The most visible effect of the PHE for nursing homes was suspension of the requirement for a three-day stay in an acute care hospital before qualifying for Medicare Part A coverage for a SNF stay. This provision solved the continuing problem of acute care hospitals keeping people in the hospital under observation status without admitting them. The suspension made it easier to get skilled care for those who needed it. A return to normal means the three-day rule will once again be in force. However, if the resident is enrolled in a Medicare Advantage plan, the suspension may remain in place, depending on whether the plan is approved by the Centers for Medicare & Medicaid Services (CMS).

During the PHE, states were granted an increase in the Federal Medicaid Matching Percentage (FMAP), and eligibility requirements were relaxed. Federal rules did not allow states to remove people from the Medicaid rolls if they were later determined to be ineligible for the program. In April, under the authority of the Inflation Reduction Act, states will be able to purge Medicaid rolls if they determine a recipient is ineligible. To soften the blow, CMS has authorized these displaced persons to enroll in Affordable Care Act plans during a special enrollment period.

The Consolidated Appropriations Act of 2023 allows states to retain a portion of the FMAP enhancement over time – provided they manage the transition in a way that alleviates the impact of coverage losses for those who will be removed from Medicaid coverage. The Kaiser Family Foundation estimates that, of the 20 million people who gained Medicaid coverage between 2019 and 2022, about six percent are aged or disabled.

How the End of the PHE Affects Pharmacy

Under the PHE, the COVID-19 vaccine was free to everyone, and pharmacists received a $40 fee for providing immunizations. The requirement for private health plans to provide vaccines for free expires with the end of the PHE, but the reimbursement for administering the vaccine in public programs extends through the end of 2023. Beginning in 2024, the administration fee for COVID-19 immunizations will be in line with other Medicare Part B vaccines.

Approved treatments for COVID-19 have been made available without cost to the recipient. This ends with the end of the PHE, too, but the Secretary has announced that access to vaccines and treatments will generally not be affected.

The ability to prescribe controlled substances without an in-person consultation will end with the expiration of the PHE. The Drug Enforcement Administration will be issuing new regulations allowing for the continuance of this practice in limited circumstances.

Stay Tuned for More on the PHE

The end of the PHE represents a major turning point in U.S. healthcare. HHS is continuing to roll out announcements over the course of the next several weeks on how it plans to alter policy and what accommodations it intends to allow. Everything changes, and that’s truer than ever in the healthcare space.

X Factors for Navigating the End of the Public Health Emergency

  • Stay up to date. Stay connected with ASCP® and NCPA® as well as your state pharmacy association to follow how the rules will be changing.
  • Stay close to your customers and find out what they’re doing to prepare – and especially how you can help.
  • Keep alert to the new opportunities to improve care as the landscape changes.

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Written by: Paul Baldwin, Baldwin Health Policy Group
Paul’s pharmaceutical industry experience in public and government affairs led to becoming Executive Director of the Long Term Care Pharmacy Alliance, helping lead the industry through the Medicare Modernization Act and creation of the prescription drug benefit. Paul was VP of Public Affairs for Omnicare before founding Baldwin Health Policy Group.

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