Public Health Emergency Likely to Remain in Place, at Least for Now

On Monday, May 16, the Department of Health and Human Services (HHS) passed a self-imposed 60-day deadline to notify states that they did not plan to extend the Public Health Emergency (PHE), which has been in place since Jan. 31, 2020. HHS most recently extended the PHE for 90 days through July 15, 2022. It is now assumed that the PHE will go through mid-October, if not longer.

The existence of the PHE allows for regulatory flexibilities for patients, providers and payors to receive reimbursement for telehealth services; provide additional federal matching dollars for Medicaid; ensure continuous coverage for Medicaid patients; and continue coverage of COVID-19 testing and vaccines. 

Private Insurance
Testing, Treatment and Vaccine Coverage
Many of the requirements imposed on private payers related to COVID-19 testing are tied to the expiration of the PHE. The CARES Act and related legislation requires private insurers to cover COVID-19 tests and testing-related services at no cost to the enrollee and with no prior authorization. This also includes point-of-care PCR tests, and applies tests and related services provided by out-of-network providers as well. In January 2022, guidance from CMS required group health plans and individual plans to pay for over-the-counter rapid COVID-19 tests as well. This guidance relies on authorities from the CARES Act and FFCRA and requires plans to pay for eight over-the-counter tests per month, per enrollee, up to $12 per test, and no doctor’s authorization is required. Once the PHE ends, all of these requirements will end, resulting in some enrollees paying cost-sharing for PCR and over-the-counter tests going forward, and potentially reducing access for some enrollees.

Source: https://www.jdsupra.com/legalnews/public-health-emergency-likely-to-4456556