CMS Fact Sheet: CMS Waivers, Flexibilities, and the Transition Forward From the COVID-19 Public Health Emergency (Feb. 27, 2023)
HHS’s Center for Medicare & Medicaid Services (CMS) has issued a fact sheet addressing the end of the COVID-19 public health emergency (PHE), which (along with the COVID-19 national emergency) is anticipated to end on May 11, 2023 (see our Checkpoint article). The fact sheet, which is addressed to individuals, confirms that HHS is expecting the PHE to expire at the end of the day on May 11 and provides information about the implications for coverage under private health insurance, as well as Medicare, Medicaid, and CHIP. Here are highlights relevant to employer-sponsored group health plans:
COVID-19 Vaccines, Testing, and Treatments. Most plans must continue to cover vaccines furnished by in-network providers without cost sharing but may require individuals receiving vaccines from out-of-network providers to share part of the cost. [EBIA Comment: For non-grandfathered plans, in-network COVID-19 vaccines without cost sharing will continue to be required under the Affordable Care Act’s preventive services coverage mandate.] When the PHE ends, mandatory coverage for OTC and laboratory-based COVID-19 PCR and antigen tests will end. Plans may choose to cover these tests but may require cost sharing, prior authorization, or other forms of medical management. The end of the PHE will not change how COVID-19 treatments are covered; plans that require cost sharing or apply deductibles may continue to do so.
Access to Telehealth Services. As is currently the case during the PHE, coverage for telehealth and other remote care services may vary from plan to plan after the PHE ends. When covered, plans may impose cost-sharing, prior authorization, or other forms of medical management.
EBIA Comment: While the fact sheet specifies implications for private health insurance, the listed items are also relevant to self-insured plans. The fact sheet notes that the agencies will continue to provide guidance in the coming months. Group health plan sponsors should especially be on the lookout for guidance regarding the end of the COVID-19 national emergency, which will trigger the 60-day countdown to the end of the outbreak period and the end of the tolling period for many plan-related deadlines (see our Checkpoint article). For more information, see EBIA’s Group Health Plan Mandates manual at Section XVI.C (“COVID-19: Mandated Coverage of Diagnostic and Preventive Services”) and EBIA’s Self-Insured Health Plans manual at Section XIII.C.11 (“Coverage Mandates Relating to the COVID-19 Pandemic”), which will be updated for guidance.
Contributing Editors: EBIA Staff.