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Unwinding the Public Health Emergency
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What physicians, physician assistants, and practices need to know about the end of pandemic flexibilities.

Unwinding the Public Health Emergency

The public health emergency issued in response to the COVID-19 pandemic formally ended Thursday, May 11. Many flexibilities at both the state and federal levels will be discontinued, while others will stay in place for a bit longer. If your practice has utilized these pandemic flexibilities, here is what you need to know.

HHS COVID-19 public health emergency transition roadmap

For an overview of flexibilities that will and will not be impacted at the end of the federal public health emergency on May 11, review the U.S. Department of Health and Human Services COVID-19 Public Health Emergency Transition Roadmap.

Telehealth platforms must be HIPAA-compliant by Aug. 9

During the public health emergency, the HHS Office for Civil Rights exercised enforcement discretion allowing physicians, physician assistants, and other licensed health professionals to use telehealth in good faith, even if their platforms or software were not compliant with the Health Insurance Portability and Accountability Act. The federal government has granted a 90-day transition period—until Aug. 9, 2023—for practices to come into compliance with HIPAA requirements as they pertain to telehealth platforms.

During this 90-day transition period, the Office for Civil Rights will continue to exercise its enforcement discretion and will not penalize covered health care professionals for noncompliance with the HIPAA rules that occurs in the course of the good faith provision of telehealth services. The agency has also published clarifying guidance on when and how HIPAA applies to telehealth.

State-regulated health insurance plans must continue to pay at parity for telemedicine services

WSMA-supported legislation requiring health insurance plans regulated by the Washington State Office of the Insurance Commissioner to pay at parity for service delivered via telemedicine has taken effect permanently. This requirement will not end with the public health emergency unwinding. The law does not apply to plans not regulated by the OIC, including certain self-insured and ERISA plans.

WSMA-supported legislation requiring insurers to provide the same coverage and reimbursement for audio-only telemedicine services as they would for care delivered in-person or via audio-visual telemedicine will also remain in effect. The law does not apply to plans not regulated by the OIC, including self-insured and ERISA plans. Effective Jan. 1, 2023, an "established relationship" is required for audio-only telemedicine services:

  • For behavioral health services, including substance use disorder treatment, a physician or PA can establish a relationship with the patient with one in-person visit or audio-visual telemedicine visit within the past three years. This change is permanent.
  • For all other health care services, for calendar year 2023, a physician or PA can establish a relationship with the patient with one in-person visit or one audio-visual telemedicine visit within the past two years. For calendar year 2024 and beyond, a physician or PA must have at least one in-person visit with the patient within the past two years to establish a relationship.

Additional telemedicine considerations: Medicare and Medicaid

Apple Health (Medicaid) will no longer reimburse for services provided over email or text. The HHS Office for Civil Rights announced that the Notification of Enforcement Discretion for Telehealth Remote Communications during the COVID-19 public health emergency will end on May 11. Effective for dates of service on and after May 11, the Washington State Health Care Authority will no longer cover emailing or texting as an option for providing services via telemedicine. See HCA's billing guides and fee schedules under Telehealth for more information; email questions to

The Centers for Medicare and Medicaid Services is developing an FAQ resource to answer many questions associated with telemedicine billing and coding. WSMA staff will add this FAQ, along with other guidance related to the transition out of the public health emergency, on our COVID-19 professional resources webpage.

In the meantime, you may review the below resources on telemedicine:

DEA requirements for prescribing buprenorphine via telemedicine are changing

During the federal public health emergency, the U.S. Drug Enforcement Administration waived the requirement that a physician or PA must have an established relationship with a patient prior to prescribing controlled substances to ensure patient continuity of care. In anticipation of the end of the public health emergency, the DEA has proposed rules that would allow practitioners to prescribe a 30-day supply of non-narcotic controlled medications, including buprenorphine, via telemedicine or audio-only telemedicine encounters without an in-person medical evaluation. Prescribing controlled substances beyond the initial 30-day supply will only be authorized for practitioners who have conducted an in-person medical evaluation. After receiving extensive feedback from organized medicine on concerns with the proposed telemedicine rules, the DEA and the Substance Abuse and Mental Health Services Administration this week issued a temporary rule extending the pandemic telemedicine flexibilities for six months while the agencies continue to consider the rulemaking.

Reimbursement for personal protective equipment ending

In the spring of 2021, WSMA's first-in-the nation legislation requiring state-regulated commercial insurance carriers to reimburse $6.57 per patient encounter for personal protective equipment through the federal public health emergency is set to expire on May 11.

HCA, DSHS redetermining Medicaid client renewals

The Health Care Authority and Department of Social and Health Services resumed normal operations on April 1, 2023, which means they have begun the process of redetermining client renewals. Termination of coverage for non-renewals will resume May 31, 2023. Most individuals on Apple Health can apply for or renew their coverage through WA Healthplanfinder. Additionally, WA Healthplanfinder will attempt to auto-renew individuals' coverage 60 days prior to the end of their renewal date.

If you see Apple Health clients in your practice, consider posting this printable flyer, which urges patients to ensure their contact information is up to date so they can be contacted about the Medicaid coverage renewal process. You may also direct your Apple Health clients to HCA's Report a Change webpage where they can review and update their contact information.

With questions on these or any other items related to the end of the public health emergency, contact the WSMA policy team at

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