Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Public Health Emergency (PHE) was declared for the same by the federal government. In March 2020, a public health emergency (PHE) declaration was issued under Section 201 of the National Emergencies Act.
This PHE lasting for 90 days has been extended several times and is currently scheduled to expire in mid-April 2022. The federal government has said that it will give states a 60-day notice before the PHE expires. Medicare and Telehealth Coverage services will decrease once the PHE ends.
Medicare Coverage at End of 319 PHE
Millions of people have received free COVID-19 testing and testing-related services, certain treatments, and vaccines during the PHE, but not all of these items will continue to be free when the PHE ends.
- Medicare beneficiaries will face cost-sharing requirements for at-home tests, testing-related services, and all COVID-19 treatments when the PHE ends. Coverage of COVID-19 vaccines will continue at no cost due to statutory changes made by the CARES Act that added coverage of COVID-19 vaccines to Medicare Part B. Clinical diagnostic testing is also covered at no cost.
- Hospitals will no longer receive the 20 percent pay increase for discharges of patients diagnosed with COVID-19 when the PHE expires. Between January 2020 and November 2021, Medicare payments for the approximately 1 million beneficiaries in traditional Medicare hospitalized for COVID-19 hospitalizations over a time period total $23.4 billion, or just over $24,000 per patient.
- Medicare beneficiaries will again need to satisfy the 3-day prior hospitalization requirement in order to have Medicare coverage of SNF stays when the PHE expires.
- Medicare Advantage enrollees who have been protected from higher out-of-pocket costs associated with services received from out-of-network providers could face higher costs when the PHE expires.
- Part D plans will no longer be required to issue extended supplies for all Part D drugs they cover after the PHE ends. Under policies in place in 2020 prior to the pandemic, most Part D enrollees were in plans that covered extended supplies of generic drugs, but only a small share had access to extended supplies of specialty drugs.
- Normal rules and regulations for Medicare program requirements and conditions of participation will apply to all applicable providers and suppliers once the PHE ends.
Telehealth Coverage at End of 319 PHE
Expanded coverage of telehealth during the PHE has enabled millions of people to access health care services that they might otherwise have foregone during the pandemic. Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic, and telehealth accounted for 12 percent of all services used by beneficiaries during the first year of the pandemic.
- Most Medicare beneficiaries will lose access to coverage of nearly all telehealth services on the 152nd day after the expiration of the PHE unless they reside in rural areas or enroll in Medicare Advantage.
- Based on changes in the Consolidated Appropriations Act of 2021, Medicare has permanently removed geographic restrictions for mental health and substance use services and permanently allows beneficiaries to receive those services at home. Medicare also now permanently covers audio-only visits for mental health and substance use services.
- Post-pandemic Medicaid telehealth policies were under consideration in most states, with many states planning to maintain all or some expanded telehealth policies that were adopted during the COVID-19 pandemic. In states that choose not to continue these policies, however, enrollees may lose access to telehealth services.
Privately insured individuals could incur additional out-of-pocket costs for tests and related services when the 319 PHE ends. People with private insurance will continue to have coverage of COVID-19 vaccines at no cost from in-network providers, due to statutory changes made by the CARES Act that extended the requirement under private insurance for coverage of preventive services at no cost to include COVID-19 vaccines.
People with private insurance who receive COVID-19 vaccines, including booster doses, from out-of-network providers, could incur out-of-pocket costs when the 319 PHE ends. shared proposed Medicare and Telehealth coverage for reference only, you can visit the CMS for any updates and their implementation date.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. Our team keeps a close watch on revised coverage to ensure accurate insurance reimbursements.
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Reference: What Happens When COVID-19 Emergency Declarations End?
FAQs
1. What happens to Medicare coverage when the PHE ends?
After the PHE ends, Medicare beneficiaries will face cost-sharing for COVID-19 testing, treatments, and at-home tests, although vaccines and clinical diagnostic testing will remain free.
2. Will Medicare pay extra for COVID-19 hospital discharges after the PHE?
No, the 20% pay increase for COVID-19-related hospital discharges will end once the PHE expires.
3. How will Medicare Advantage coverage change after the PHE?
Medicare Advantage enrollees may face higher out-of-pocket costs for services from out-of-network providers once the PHE ends.
4. What will happen to telehealth coverage for Medicare beneficiaries after the PHE?
Most Medicare beneficiaries will lose access to telehealth coverage, except for those in rural areas or those enrolled in Medicare Advantage.
5. How will private insurance coverage change after the PHE?
Private insurance will continue to cover COVID-19 vaccines at no cost but may introduce out-of-pocket costs for tests and services once the PHE ends.
