Post Public Health Emergency FAQ
The COVID-19 Public Health Emergency (PHE) ended on May 11, 2023—which changes many federal policies established during the pandemic. OSMA is working to keep members updated as guidance is available.
Q: When the PHE ends, can individuals continue to see providers virtually using telehealth?
Yes, in most cases. During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply. These waivers were included as provisions of The Consolidated Appropriations Act, 2023, which extended many telehealth flexibilities through December 31, 2024, such as:
- People with Medicare can access telehealth services in any geographic area in the United States, rather than only in rural areas.
- People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
- Certain telehealth visits can be delivered using audio-only technology (such as a telephone) if someone is unable to use both audio and video (such as a smartphone or computer).
However, if an individual receives routine home care via telehealth under the hospice benefit, this flexibility will end at the end of the PHE.
MA plans may offer additional telehealth benefits. Individuals in an MA plan should check with their plan about coverage for telehealth services. Additionally, after December 31, 2024, when these flexibilities expire, some ACOs may offer telehealth services that allow primary care doctors to care for patients without an in-person visit, no matter where they live
Q: Will audio-only telehealth visits be reimbursable after May 11, 2023?
Per CMS, audio-only telehealth visits, in general, will be covered through Dec. 31, 2024. For dates of service after Dec. 31, 2024, only behavioral/mental health audio-only visits will be covered.
Q: What Medicaid telehealth flexibilities will end, and what flexibilities will remain in place?
No flexibilities will end. For Medicaid and CHIP, telehealth flexibilities are not tied to the end of the PHE and have been offered by many state Medicaid programs long before the pandemic. Medicaid and CHIP telehealth policies will ultimately vary by state. CMS encourages states to continue to cover Medicaid and CHIP services when they are delivered via telehealth.
Hear more about post-PHE policies.
Register for OSMA’s 2023 Medicare & Medicaid Updates this August!
LIVE WEBINAR SERIES >
Q: How much will CMS pay health care providers to administer COVID-19 vaccines through the end of the 2023 calendar year?
Under the Medicare Part B preventive vaccine benefit, CMS will continue to pay approximately $40 per dose for administering COVID-19 vaccines through the end of the calendar year in which the Secretary ends the Emergency Use Authorization (EUA) declaration for drugs and biologicals with respect to COVID-19. The COVID-19 EUA declaration has not ended. Effective January 1, 2024, CMS will set the payment rate for administering COVID-19 vaccines to align with the payment rate for administering other Part B preventive vaccines, which is currently approximately $30 per dose. 3 These payment rates do not apply in settings that are paid at reasonable cost for preventive vaccines and their administration (for example, Federally Qualified Health Centers and Rural Health Clinics). If someone is enrolled in an MA plan, the provider should submit claims for vaccine administration to the MA plan, and the amount the provider is paid for the vaccine administration service is determined by the contract between the MA plan and the provider, if there is a contract. If there is no contract in place.
Q: When the PHE ends, will the additional payment for at-home COVID-19 vaccinations continue?
Medicare will continue to pay an additional amount of about $36 in addition to regular administration fees for the administration of COVID-19 vaccines at home when the PHE ends. This additional Medicare payment for at-home COVID-19 vaccinations will continue through the end of calendar year 2023. For individuals enrolled in a MA plan, provider payment rates are determined by the contract between the MA plan and the provider when such a contract is in place and may or may not include additional payments for at-home COVID-19 vaccinations. If there is no contract in place for vaccinations covered by the MA plan, the Medicare payment rate would apply.