NIC Notes

Insights in Seniors Housing & Care

By: Ryan Brooks  |  April 19, 2023

Three Areas to Monitor as Public Health Emergency Approaches End

COVID-19  |  Regulatory Environment  |  medicaid  |  medicare  |  telehealth

Ryan Brooks WebsiteBased on current COVID-19 trends, the Department of Health and Human Services is planning for the federal Public Health Emergency (PHE) for COVID-19 to expire on May 11, 2023. The impacts of the public health emergency ending will vary by state, depending on specific policies and programs that were put in place during the emergency.

Certain flexibilities and waivers that were granted during the emergency are planned to sunset, and regulations and restrictions may be reinstated. For senior housing and care operators, three areas to be aware of include Medicaid redeterminations (which are currently underway), cost-sharing on COVID-19 testing and treatments, and the continuation of certain telehealth flexibilities. 

Medicaid Redeterminations

In March 2020, the Families First Coronavirus Response Act (FFCRA) was signed into law. A key provision of the legislation required states to maintain enrollment of nearly all Medicaid enrollees throughout the COVID-19 Public Health Emergency. This stipulation was a condition of receiving a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP). 

Medicaid enrollment has grown substantially compared to prior to the pandemic, largely due to this legislation. As a result, the uninsured rate dropped. However, as states begin the process of Medicaid redeterminations, it is expected that between 5 million and 14 million current Medicaid beneficiaries will lose their eligibility. These changes may affect coverage of services provided by assisted living communities under home- and community-based services. 

While the share of disenrolled across states will vary due to differences in how states prioritize renewals, it is expected that the groups that experienced the most growth due to the continuous enrollment provision will experience the largest declines in enrollment. Efforts to conduct outreach, education, and provide enrollment assistance can help ensure that those who remain eligible for Medicaid are able to retain coverage and those who are no longer eligible can transition to other sources of coverage.

The Consolidated Appropriations Act, passed in 2023, delinked the FFCRA’s Medicaid continuous enrollment from the ending of the public health emergency. As a result, beginning April 1, 2023, states are able to begin the termination process for Medicaid enrollees who are no longer eligible. 

Cost-Sharing on COVID-19 Testing and Treatments

Medicare beneficiaries will continue to have access to COVID-19 vaccines without cost sharing even after the PHE has ended. Additionally, Medicare beneficiaries can continue to receive COVID-19 PCR and antigen tests with no cost sharing, as long as the test has been ordered by a physician or other qualified health care provider and is performed in a laboratory. Medicare Advantage enrollees can also continue to receive PCR and antigen testing, although following the end of the PHE, their cost-sharing may change. By law, Medicare does not generally cover over-the-counter services and tests. As such, current access to free over-the-counter COVID-19 tests will end with the end of the PHE. 

There will be no change in Medicare coverage of treatments for those exposed to COVID-19 once the PHE ends. In cases where cost-sharing and deductibles applied during the COVID-19 emergency, they will continue to apply. 

Telehealth Flexibilities Remain – For the Time Being

The Department of Health and Human Services took a range of administrative steps to expedite the adoption and awareness of telehealth during the COVID-19 pandemic. During her confirmation hearing, CMS Administrator Chiquita Brooks-LaSure, indicated that she wanted to examine what CMS’ authority was to extend the flexibilities that were set to expire at the end of the public health emergency. Many of the flexibilities that were put into place– the originating site rule, mental health visits by rural health clinics, and allowing for audio-only telehealth visits have been extended through the end of 2024.

Projected shortages of primary care physicians and specialists, as well as uncertainty on the numbers of nurses that will be available to serve the needs of a rapid expanding population of seniors, highlight the need for telehealth to be a more routine part of care delivery. Technology has enabled physicians to use their medical offices to see higher-acuity patients. This method of care both lowers cost and improves outcomes, and as such, CMS should continue to support the expansion of telehealth and telehealth flexibilities.  

To see the complete list of CMS waivers and flexibilities that will be impacted by the May 11, 2023 end of the COVID-19 Public Health Emergency, please reference the CMS Fact Sheet that covers COVID-19 vaccines, testing, and treatments, telehealth services, and health care access. 

About Ryan Brooks

Senior Principal Ryan Brooks works with the research team in providing research, analysis, and contributions in the areas of healthcare collaboration and partnerships, telemedicine implementation, EHR optimization, and value-based care transition. Prior to joining NIC, he served as Clinical Administrator for multiple service lines within the Johns Hopkins Health System, where he focused on patient throughput strategies, regulatory compliance, and lean deployment throughout the organization. Brooks received his Bachelor’s in Health Services Administration from James Madison University and his Master’s in Business Administration from the University of Maryland.

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