To Extend or Not Extend? Biden Administration Prepares States for Decision on PHE

The current COVID-19 public health emergency (PHE) declaration ends on July 15. Notification of the PHE’s end is anticipated by Monday, May 16, given the Biden administration’s promise to provide states with a 60-day warning to support a smooth post-PHE transition.

There has been some discussion about continuing the PHE another 90 days given the increase in cases due to Omicron and its subvariants, as well as the administrative ease of continuing COVID-19 flexibilities through the fiscal year (a renewal of the PHE declaration would extend it to October 13, 2022). Another extension would also ensure telehealth flexibilities continue beyond the end of the calendar year. Separate from other temporary COVID-19 policies, most major Medicare telehealth flexibilities (e.g., removal of geographic and originating site restrictions, provision of audio-only services, additional provider types authorized to furnish telehealth services, etc.) were extended 151 days past the end of the PHE by Congress in the 2022 Consolidated Appropriations Act (CAA). This means these telehealth flexibilities will end on December 13 with no renewal of the PHE, but would continue to mid-March if the PHE is reauthorized another 90 days.

Despite these considerations, the general consensus is that it seems more likely that the PHE will not be renewed. The Biden administration is likely interested in moving on from the PHE ahead of the midterm elections in November so it can focus voters on what has been accomplished to date and its vision for the future. Continuing to operate under a public health emergency declaration does not help to advance the message that the country is recovering from the financial impact of the pandemic.

The Centers for Medicare & Medicaid Services (CMS) has also taken meaningful steps to prepare state health officials for the PHE’s end. In early March, CMS sent a letter promoting continuity of coverage after the end of the PHE. The letter detailed how to begin the Medicaid eligibility renewal process after the PHE ends, it also clarified that states must initiate, rather than complete, all pending actions during the 12-month unwinding period post-PHE. Finally, the letter noted CMS’ intention to collect information from all states about their plans to adopt strategies that will promote continuity of coverage and guard against inappropriate terminations. The agency explained that it will also monitor states’ progress in completing required eligibility and enrollment actions.

Following-up on its letter, in late March CMS released specifications for state data reporting to help the agency monitor the unwinding of the Medicaid continuous coverage protection. States must report baseline data for the month prior to when the state initiates renewals and submit monthly data by the 8th of the month for the prior month. CMS also released a form that states must complete and submit 45 days before the end of the month in which the PHE ends that summarizes how the state will distribute renewals and protect against inappropriate coverage loss during the unwinding.

Most recently, a group of 16 leading health organizations urged Secretary Becerra to sustain the PHE pending a clear indication that the pandemic “has receded and the capabilities authorized by the PHE are no longer necessary” via a letter sent Tuesday. The letter highlights concern around patient access to vaccines, tests, and treatments, workforce considerations and operational readiness, and Medicaid redeterminations of eligibility for coverage, if the PHE is not reauthorized. Also on Tuesday, the Department of Health and Human Services (HHS) told governors that it did not yet know when the PHE would end. Regardless, the Department made it clear that states should now prioritize post-pandemic planning, including identifying the COVID-19 flexibilities they intend to keep after the PHE expires.

With the promised 60-day buffer drawing near, these actions by CMS are the strongest signals we have received to date of the administration’s intentions regarding the PHE declaration. All players in the health system should take note and seriously consider the changes that will need to be made over the next few months to “return to normal.”

To aid in these efforts, WHG has compiled a comprehensive chart that delineates a comprehensive set of temporary flexibilities pursuant to the COVID-19 public health emergency (PHE), available here. Development of this chart was made possible through WHG’s partnership with The Commonwealth Fund.

Lauren Testa has experience working with a diverse range of clients – including, investors and lenders, federal and local government