3 Years, 39 Months, 1,196 Days, 28,703 Hours. That’s how long the COVID-19 Public Health Emergency (PHE) has been in effect. Can you believe it? Over three years ago today the initial COVID-19 PHE provided the first of many flexibilities to health centers to boost their response on the front lines of a new global pandemic. Under both the Trump and Biden Administration, the PHE has been extended 12 times. Today, the running streak of the PHE officially ends (May 11, 2023), due to the Biden Administration concluding the PHE at 11:59 PM.

The Path to the End: How Did We Get Here?

The COVID-19 Public Health Emergency was first declared by the U.S. Department of Health and Human Services (HHS) on January 31, 2020.  The declaration allowed the HHS Secretary of to provide flexibility to state and local health departments in their pandemic response.

As the COVID-19 virus continued to spread, then President Donald Trump declared the COVID-19 National Emergency on March 31, 2020.  The move directed the HHS Secretary to temporarily waive or modify requirements related to Medicare, Medicaid, and State Children’s Health Insurance Programs (CHIP) and HIPPA. Under the authority of the National Emergency, HHS issued blanket waivers for federal Medicaid & Medicare requirements with a particular focus on: 

• Waiving certain Medicare provider enrollment requirements. 
• Waiving requirements for in-person meetings between providers and patients.  
• Waiving requirements for out-of-state Medicare and Medicaid providers to be licensed in the state where they were providing services. 

States were also allowed to request time-limited flexibility for their Medicaid and CHIP programs through 1135 Waivers. Many 1135 waivers will terminate at the end of the COVID-19 PHE.  To find your state specific waivers please visit the following link.

What Will Happen to the Flexibilities Provided to Health Centers?

Telehealth: Throughout the pandemic, health center Medicare patients were able to access telehealth services in any geographic area in the United States. The pandemic policy flexibilities allowed patients with Medicare to stay in their homes for telehealth visits, rather than traveling to a health care facility. These pandemic flexibilities have been extended through December 31, 2024. For patients with Medicaid or CHIP, coverage will vary by state. The Centers for Medicare and Medicaid Services (CMS) encourages states to continue to cover Medicaid and CHIP services when they are delivered via telehealth. Lastly, telehealth coverage for patients with private health insurance will vary depending upon their plan specific details after the end of the PHE. When covered, private insurance may impose cost-sharing, prior authorization, or other forms of medical management on telehealth and other remote care services.

Behavioral Health Visits: Health centers can provide virtual mental health services to patients and receive their prospective payment system (PPS) encounter rate, without any geographic requirements for the patient or provider. This includes visits furnished using interactive, real-time telecommunications and audio-only technology.  Starting in 2025, Medicare will require health centers to have an initial in-person visit within six months of a telehealth encounter and a 12-month subsequent in-person visit following the telehealth encounter, at the provider’s discretion.

• Health centers were able to provide COVID-19-related services to non-established patients and were still covered for malpractice liability under the FTCA. This flexibility allowed health center employees to provide services in response to COVID-19 to both established and non-established patients of the health center, whether at the health center, or offsite, and whether in person or through telehealth. At the conclusion of the COVID-19 PHE (May 11, 2023) there is no clear end date for this flexibility.

Workforce Flexibilities: Health Centers had the ability to add temporary sites in response to the COVID-19 PHE. Additionally, the National Health Service Corps (NHSC) also provided flexibility for provider participants. Throughout the pandemic, the NHSC provided the following flexibility to participants:

• Waiving the requirement of not being away from an approved service site for more than the allotted seven weeks per service year.
  • Providing flexibility due to unemployment as a direct result of the COVID-19 outbreak.
  • Allowing employer-directed care outside of an NHSC-approved health care facility.

When the PHE ends today both the temporary site location and NHSC flexibilities will conclude.

Administering the COVID-19 Vaccine: HHS amended the Public Readiness and Emergency Preparedness (PREP) Act to expand who could order and administer the COVID-19 vaccine. Dentists, Pharmacists, Midwives, Paramedics, EMTs, Physician Assistants, Respiratory Therapists, Podiatrists, Optometrists, and Veterinarians have been able to provide COVID-19 vaccines.

HHS Amended the PREP Act again last month to extend pharmacists, pharmacy interns, and pharmacy technicians’ ability to administer the COVID-19 vaccine and be protected from liability under the PREP Act through December 2024. These protections were extended regardless of whether vaccines are available on the commercial market or under emergency use authorization. The above groups will continue to be protected from liability claims as they administer COVID-19 and flu vaccines and tests to people ages 3 and older, consistent with other requirements, even after the public health emergency ends on May 11. Non-traditional vaccinators, like students and recently retired providers, will no longer be covered once the vaccines hit the commercial market.

NACHC Resources to Help Navigate a Post PHE Environment:

Health Center COVID-19 Flexibilities Tracker: To assist PCAs in tracking pandemic-related flexibilities, NACHC has developed a tracking document that breaks down all flexibilities that were provided to health centers throughout the pandemic. View the COVID-19 Flexibilities Tracker. 

COVID-19 Vaccines, Testing, & Treatment: Curious about whether payers (private and public) will cover COVID-19 related services? NACHC’s blog post breaks down specifics into coverage for each payer group after the PHE. Additionally, CMS put out two fact sheets for patients to better understand how their coverage may change after today. Follow these links for the English and Spanish version of the factsheets. 

Medicaid Redetermination Listening Sessions: NACHC continues to host monthly listening sessions on Medicaid redeterminations. We encourage PCA and health center staff to register, attend and share your insights on redeterminations in your state. We also use an online information hub, Noddlepod, to share the most recent information related to Medicaid redeterminations. To stay up to date, sign up for Noddlepod access here. As always, if you have feedback on topics to address in the next listening session, please email federalpolicy@nachc.org.