What Social Workers Need to Know About the End of the Public Health Emergency

At the end of January, the Biden Administration announced that the COVID-19 Public Health Emergency (PHE) will be allowed to expire on May 11, 2023. What does that mean for social workers and their clients? NASW-NC will update this page as new information becomes available.

• Telehealth flexibilities with Medicare will remain until December 2024, including the ability to provide telehealth to Medicare beneficiaries in any area, and the ability to deliver visits via smartphone. It's up to each state whether the flexibilities are extended beyond that, or if flexibilities will be extended at all beyond May 2023 for Medicaid. There is no word yet on whether NC will definitely extend or not, but it looks like they plan to.

• Access to and cost of COVID vaccines and boosters will stay the same. The cost of at-home COVID tests will increase for those with insurance, and will be free for Medicaid recipients until September 2024. Medicare beneficiaries may face cost-sharing requirements for certain COVID pharmaceutical treatments after May 11.
  

• During the public health emergency, providers writing prescriptions for controlled substances were allowed to do so via telemedicine, but in-person visits will be required after May 11, 2023.
  

• Because of the pandemic, all states and D.C. temporarily waived some aspects of state licensure requirements so that providers with equivalent licenses in other states could practice remotely via telehealth. Some states tied those policies to the end of the federal public health emergency so those policies may end unless those states change their policy. The North Carolina Social Work Licensure Board has indicated to NASW-NC that there are no anticipated changes to the statute and rules governing social work practice in North Carolina at this time.

• The Department of Health and Human Services temporarily waived penalties against providers using technologies that don’t comply with federal privacy and security rules in the provision of telehealth services during the public health emergency. Enforcement of these rules when the public health emergency ends will restrict the provision of telehealth to “HIPAA compliant” technologies and communication productions.
  

• Effective April 1, 2023, state Medicaid programs are no longer required to maintain continuous coverage for beneficiaries. North Carolina will begin the renewal (recertification) process for Medicaid beneficiaries April 1, 2023. Recertifications will be completed over the next 12 months, as beneficiaries are up for renewal. Recertification could result in a beneficiary’s termination or reduction of benefits.

• In March 2023, the SNAP emergency allotment payments will end, resulting in an estimated benefit cut of $181 per household and $88 per person in North Carolina.

Below the Center for Connected Health has also provided a detailed breakdown of what stays and what goes when the PHE ends as it stands now:

 
What stays permanently:

• Medicare reimbursement for eligible telehealth services when the patient is located in a geographically rural area AND in an eligible originating site (i.e. in most cases not the home).

• Medicare reimbursement for mental health telehealth services (including audio-only services in some cases), provided that there is an in-person visit within the first six months of an initial telehealth visit and every 12 months thereafter (with certain exceptions). Implementation of this in-person requirement is delayed until Jan. 1, 2025.  There is also an exception from the in-person requirement for substance use disorder treatment or a co-occurring mental health disorder and treatment for end stage renal disease.

• Medicare reimbursement to federally qualified health centers and rural health clinics, although it will no longer be billed the same or for ‘telehealth’ specifically, for mental health services delivered via audio-only or live video.  CMS has redefined a ‘mental health visit’ to now include encounters furnished through interactive, real-time telecommunications technology (which will include audio-only delivery in some cases) for a mental health disorder.

What stays on a temporary basis until Dec. 31, 2024, but will go away afterward:

• Medicare reimbursement for telehealth services provided to patients at home, aside from certain exceptions.

• Medicare reimbursement for an expanded list of eligible providers, such as occupational therapists, physical therapists, speech language pathologists and audiologists.

• Medicare coverage of audio-only telehealth for non-mental health visits.

• Reimbursement of FQHCs and RHCs as distant site telehealth providers for non-mental health services.  As noted above, FQHCs and RHCs will continue to be reimbursed for ‘interactive, real-time telecommunications technology’ for a mental health disorder but these are not regarded as “telehealth” services for these entities.

• Reimbursement of Medicare telehealth services not included in Medicare’s Categories 1, 2 or 3, will be allowed for a 151-day extension period (unless altered by CMS given the two-year extension of the other telehealth flexibilities) but will expire afterward. Includes codes such phone E/M codes 99441-99443.

Available through the calendar year in which the PHE ends:

• Codes on Medicare’s Category 3 telehealth list [see page 3-4 of CCHP’s 2023 PFS factsheet for list], will remain reimbursable through the end of the year in which the PHE ends, likely extending it to Dec. 31, 2023.  Some of these codes may eventually be incorporated into Categories 1 (services similar to services already on permanent telehealth list) or 2 (there is sufficient evidence to show service can be provided safely and effectively via telehealth) allowing for permanent Medicare reimbursement.

• Virtual presence for direct supervision is available through the end of the calendar year the PHE ends, though CMS continues to consider comments regarding this issue for potential future PFS rulemaking.

 What goes right away:

• During the COVID public health emergency, HHS Office for Civil Rights (OCR) applied enforcement discretion to telehealth providers, allowing them to utilize any non-public facing remote communication product, even if they don’t fully comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  OCR has recently clarified in a FAQ document that the enforcement discretion will remain in effect until the Secretary of HHS declares that the public health emergency no longer exists, or upon expiration date of the declared PHE.  OCR will issue a notice to the public when it is no longer exercising its enforcement discretion.

• During the emergency, providers were able to prescribe controlled substances without an in-person examination.  This flexibility will expire with the end of the PHE, requiring providers to adhere to strict rules.  In most cases this will require a patient to be located in a doctor office or hospital registered with the DEA to be prescribed a controlled substance via telehealth.  As mentioned previously, a proposed rule would create an additional permanent exception for prescribing buprenorphine in an Opioid Treatment Program (OTP), but has not yet been finalized. 

Many state-based policies will vary depending on the end of a given state’s public health emergency and/or state of emergency, and may or may not be tied to the end of the federal public health emergency.  Almost all of the state waivers related to licensure and private payers have expired, though some Medicaid telehealth flexibilities still remain. Visit CCHP’s COVID policy tracker for more information on state-based policies.

More detailed information on the different flexibilities/exceptions that occurred during the PHE and what will happen with them at a federal level when the PHE expires can be found here.