When does the PHE end? And what does it all mean?

The end is near!

The COVID-19 Public Health Emergency (PHE) will officially end on May 11, 2023. When the PHE was declared on January 31, 2020, emergency declarations and waivers (some 1,135 of them!) were implemented, granting flexibilities to healthcare providers and state Medicaid agencies. Any waivers still in effect will terminate on May 11. Because the PHE is ending, HHS will not have the authority to extend waivers or approve new waivers, even on an individual basis, related to COVID-19.

Q: What does this mean for LTPAC?

A: Many waivers affecting patient care and facility operations in LTPAC have already been sunset in the past year. However, a few have remained active, and are now set to expire on May 11, when the PHE expires. The waivers scheduled to end on that date include:

• Medicaid Enrollment. As part of the Consolidated Appropriations Act, 2023, the continuous enrollment condition will end on March 31, 2023. The temporary FMAP increase will be gradually reduced and phased down beginning April 1, 2023 (and will end on December 31, 2023). If someone is ineligible for Medicaid, they will have until July 31, 2024, to sign up for coverage via the federal Affordable Care Act (ACA) marketplace.
• Three-Day Stay Waiver. During the PHE, the flexibility to move a patient into a SNF without the three-day acute care stay requirement opened beds to those who were critically ill. Starting May 11, SNF beds will no longer be available for patients not meeting SNF requirements.
• Immunizations. Immunizers will no longer be able to bill Medicare directly for vaccines to individuals in a Part A stay after June 30, 2023. Beginning July 1, typical SNF consolidated billing regulations will be in place.
• Temporary Nurse Aide waivers. Facilities will have until September 10 to get their TNAs trained and certified.

Q: What waivers have been extended?

A: Some waivers and pandemic related reporting requirements have been extended until December 31, 2024. These include:

• Reporting to NHSN. Reporting COVID-19 data to NHSN will continue to be required until December 31, 2024.
• Staff vaccination requirement remains in effect.
• Telehealth requirements that are not ending on May 11 include:
  • Waiver of geographic and location requirements
  • Reimbursement for telehealth services furnished by physical therapists, occupational therapists, speech language pathologists and audiologists
  • Reimbursement for audio-only services
    
    

Q:  How will COVID-19 impact operators moving forward?

A: COVID-19 has profoundly impacted the world since it emerged in 2019. Globally, the pandemic has sickened more than 675 million people and claimed the lives of more than 6.8 million, according to Johns Hopkins University. Here in the U.S., as of late February 2023, our country still led the world with the most cases – over 103 million – and more than 1.1 million deaths.

It’s not just the numbers that will linger. Regardless of May 11th marking the end of the longest public health emergency in modern American history, LTPAC operators will continue to deal with a number of important issues brought on and exacerbated by the pandemic, including:

• Continual staffing shortages
• Operational complexities surrounding staff retention
• Increased survey scrutiny
• Emphatic focus on infection prevention
• Meeting complex quality reporting requirements
• All of the above, while remaining financially sound

And, most importantly, continuing to excel in patient safety and quality of care.

Q: With the PHE ending, will we ever return to “normal?”

A: After three challenging years, the call to “return to normal operations” seems profoundly difficult if not impossible. The PHE has changed the way facilities operate indefinitely. That said, the PHE also highlighted the importance of technology to keep pace with fast-changing scenarios while assisting every step of the way.

With every regulatory change implemented during the PHE, it was critical for IT vendors to support all the changes in the least disruptive way to operators. The same goes for the unwinding and dismantling of the PHE. It is in this “new normal” that LTC operators can continue to work closely with their vendor partners to help mitigate staffing issues, improve infection prevention and control, and comply with ongoing reporting requirements.

Experts agree there will be another pandemic. Having learned from this one and putting the technological tools in place to mitigate the consequences for the next one, will prove crucial for providers.

Resources:

https://www.cms.gov/files/document/long-term-care-facilities-cms-flexibilities-fight-covid-19.pdf

https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency

https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

https://www.cms.gov/files/document/what-do-i-need-know-cms-waivers-flexibilities-and-transition-forward-covid-19-public-health.pdf

https://www.worldvision.org/disaster-relief-news-stories/what-is-coronavirus-facts