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
HCAAppleHealthClinicalPolicy@hca.wa.gov.
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
policy@wsma.org.