The COVID-19 public health emergency (PHE) was declared on February 3, 2020, was extended by 90 days 12 times, and will end on May 11, 2023. As you know, the CMS created and released waivers and flexibilities as medical professionals and organizations identified regulations that hindered medical care during the PHE. Now the CMS must carefully determine how to best return to "normal." This author has been inundated with questions pertaining to whether the hundreds of waivers and flexibilities that were enacted during the PHE will end on May 11, 2023. Some waivers and flexibilities actually ended before the PHE ended, some were extended and will end on December 31, 2023 or December 31, 2024, and some waivers and flexibilities became permanent.

For the waivers and/or flexibilities that are ending, now is the time to make plans to return to pre-COVID-19 processes. If you wish to know the status of the many other COVID-19 PHE waivers and flexibilities, visit the CMS website: https://www.cms.gov/coronavirus-waivers. The CMS has published a wealth of information about this topic and the website even has fact sheets that review the status of the waivers and flexibilities for specific places of service.

Waivers That Ended Before the PHE Ended

* Waiving the requirement that all required physician visits must be made by the physician personally, and allowing the physician to delegate any required physician visit to a NP, physician assistant (PA), or clinical nurse specialist who is not an employee of the facility, working in collaboration with a physician, and licensed by the state and performing within the state's scope of practice laws

* Waiving the required accreditation for newly enrolled durable medical equipment, prosthetics, orthotics, and supplies suppliers and extending any expiring supplier accreditation for a 90-day time period

Waivers That End on May 11, 2023

* Allowing hospital-owned provider-based departments to relocate to settings outside the hospital, including patients' homes

* Covering Medicare Part A skilled nursing facility (SNF) care without a prior 3-day hospital stay

* Making SNF beds available to patients who did not meet SNF requirements

* Allowing pharmacists to order COVID-19 tests for which Medicare paid

* Covering a beneficiary's first COVID-19 test performed by a laboratory without an order: orders are now required for all COVID-19 testing

* Providing free COVID-19 at-home tests and no-cost sharing for testing services (exception: Medicaid beneficiaries have at least an additional year of tests at no cost)

* Reimbursing for a level 1 evaluation and management visit (99211) when clinical staff assess a new or established patient and collect a specimen for a COVID-19 diagnostic test (NOTE: now only reimbursed for established patients)

* Reimbursing for subsequent hospital inpatient visits furnished via telehealth more frequently than every 3 days (99231-99233)

* Reimbursing for subsequent SNF visits furnished via telehealth more frequently than once every 14 days (99307-99310)

* Reimbursing for virtual check-in services provided by physicians (G2010, G2012) and nonphysician practitioners (G2251, G2252) for both new and established patients (NOTE: now only reimbursed for established patients)

* Allowing telehealth evaluations and assessments and waiving face-to-face visits required by National or Local Coverage Determinations

* Reimbursing for remote physiologic monitoring (RPM) services provided to both new and established patients (NOTE: now only reimbursed for established patients)

* Cutting or waiving deductibles and co-payments for telehealth or RPM

* Allowing Medicare patients in a hospital to be under the care of PAs and NPs rather than a physician

* Waiving signature and proof of delivery requirements for Part B drugs and durable medical equipment when a signature cannot be obtained because of COVID-19

Waivers That Will End on December 31, 2023

* Paying approximately $40 for administration of COVID-19 vaccines in outpatient settings (NOTE: payment rate will be reduced to approximately $30 per administration)

* Reimbursing physicians at the same rate for services provided via telehealth as those provided in person

* Allowing practitioners to provide telehealth services from their homes without reporting their home address on their Medicare enrollment, while continuing to bill from their currently enrolled location

Waivers That Will End on December 31, 2024

* Extension of Acute Hospital Care at Home initiative, which allows hospitals to expand their capacity to provide inpatient care in a patient's home

* Extension of telehealth flexibilities due to Congressional action:

* Covering of telehealth in all geographies (not only rural areas) and locations, including the patient's home

* Reimbursing for telehealth services provided by physical and occupational therapists

* Reimbursing for audio-only evaluation and management (E/M) visits (99441-99443), if patient cannot use both audio and video

* Reimbursing for telehealth services provided by federally qualified health centers and rural health centers

* Allowing the required face-to-face encounter (between the physician/allowed practitioner and the patient) for home health to be conducted via telehealth (ie, 2-way audio-video technology) when the patient is at home

* Allowing members of high-deductible health plans and health savings accounts to use "first dollar coverage" for telehealth visits without meeting their deductible

NOTE: After December 31, 2024, some Accountable Care Organizations may allow primary care physicians to care for patients via telehealth regardless of where the patients live.

Waivers That Became Permanent

* Covering the following services even when provided via telehealth:

* Home visits, new and established patients, all levels (99347 and 99348)

* Prolonged hospital inpatient or observation care E/M service(s), each additional 15 minutes (G0316)

* Prolonged nursing facility E/M services, each additional 15 minutes (G0317)

* Prolonged home or residence E/M service(s), each additional 15 minutes (G0318)

* Chronic pain management and treatment, first 30 minutes (G3002; NOTE: The first encounter must be in-person, not telehealth)

* Chronic pain management and treatment, each additional 15 minutes (G3003)

* Covering E-visits (non-face-to-face communications with the practitioner using an online patient portal) for therapists (98970-98972) in addition to physicians (99421-99423)

* Obtaining annual established patient consent for virtual check-ins at the time of service

* Allowing NPs, clinical nurse specialists, and PAs to supervise diagnostic tests as authorized under state law and licensure (NOTE: These practitioners continue to require statutory relationships with supervising or collaborating physicians)

* Allowing physical and occupational therapists to delegate maintenance therapy services to assistants

* Allowing licensed physicians and other practitioners to bill Medicare for services provided outside of their state of enrollment, if permitted by state law

* Allowing physicians, certain nonphysician practitioners, and therapists to review and verify, instead of re-documenting, information added to the medical record by any member of the healthcare team, including students

* Allowing home health agencies to use telecommunication technology (eg, RPM, audio-only telephone calls, two-way audio-video technology) within the 30-day period of care, as long as it is part of the patient's plan of care and does not replace needed in-person visits that are ordered (NOTE: Beginning July 1, 2023, home health services furnished using telecommunication systems are required to be included on the home health claim)

SUMMARY

Wound/ulcer management professionals and providers should carefully monitor all CMS communications pertaining to the status of the COVID-19 PHE waivers and flexibilities.

If you believe a particular waiver/flexibility should not end, now is the time to speak up. Individuals, healthcare organizations, professional societies, and advocacy groups should make their voices heard to CMS and to Congress while they are working on this project. In addition, if you have a particular scenario that needs clarification, email the scenario to mailto:[email protected] and include "Coronavirus Waivers and Flexibilities" in the subject line.