The White House has announced that it intends to extend (briefly) the public health emergency (PHE) one more time and then end it on May 11th, 2023. The Department of Health and Human Services (HHS) published a transition roadmap on February 9, 2023. HHS reports that they “will work closely with partners…to ensure an orderly transition.” We fully expect further guidance issued by the agencies as group health plans, carriers and vendors develop a plan to roll back certain provisions.
As a reminder, the PHE was declared by HHS and has been renewed approximately every three months since early 2020. From a benefits standpoint, the public health emergency is what requires health plans to cover various COVID related services, like vaccines and tests, at no cost.
What will be affected upon expiration of the PHE?
- The requirement for group health plans to cover COVID-19 tests without cost sharing, both for OTC and laboratory tests, will end.
- IMA comment: It’s likely that group health plans will continue to cover lab testing with cost-sharing that is already built into the plan for other simple lab tests. Please check with your carrier learn how this will be covered after May 11, 2023.
- Self-insured plans should work with their TPA to determine how or if tests will be covered after May 11.
- Out-of-Network tests and related services are no longer required to be covered by the group health plan.
- Covid-19 vaccines provided by out-of-network providers are no longer required to be covered by the group health plan.
- Reminder: Non-grandfathered group health plans must continue to cover Covid-19 vaccines and boosters in-network without cost sharing due to its addition to the list of preventive services that must covered at 100%.
- Telehealth access: certain PHE provisions made it easier for healthcare providers to practice via telehealth; specifically across state lines and without fear of HIPAA violations while using widely accessible services like Facetime or Skype.
- IMA comment: the end of the PHE means that telehealth providers will not be as accessible as they were during the PHE. We expect telehealth to continue to gain popularity, but accessible providers may be more difficult to find.
- The ability for health care providers to dispense controlled substances via telemedicine without in-person interaction.
- Note: HHS has stated that the Drug Enforcement Agency is working on rulemaking to extend these flexibilities under certain circumstances. More guidance will be available in the future.
- IMA comment: It’s likely that group health plans will continue to cover lab testing with cost-sharing that is already built into the plan for other simple lab tests. Please check with your carrier learn how this will be covered after May 11, 2023.
The national emergency will also end on May 11, 2023. This affects the extension of certain deadlines that also impacts group health plans:
- Group health plans subject to ERISA or the IRS (and certain non-ERISA plans as outlined here) must disregard “the Outbreak Period” in determining the following periods and dates: Cobra deadlines for premiums, elections and notices, HIPAA special enrollment deadlines, timeframes for filing claims, deadlines for requesting internal and external appeals for adverse benefit determinations.
With respect to the COVID deadline extensions, the Outbreak Period would extend another 60 days beyond the end of the national emergency to July 10, 2023. At this point, any suspended deadlines would begin running as normal.
For example, for a COBRA qualified beneficiary who had been offered COBRA sometime between July 11, 2022 and July 10, 2023, their 60 day election period would start up again on July 11, 2023 and would expire on September 8, 2023. Similarly, COBRA payment due dates and grace periods would also resume as of July 11, 2023.
We’d like to get specific guidance from the agencies before May 11th so we will watch closely and keep readers informed of additional guidance.
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.
This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.