The COVID-19 national emergency ended April 10, 2023. The COVID-19 public health emergency ends on May 11, 2023.
These two emergencies brought relief in a number of areas including, but not limited to, hospital stays, data reporting, testing and diagnosis, Medicare, Medicaid, CHIP and timeframes for certain benefit elections under employer health plans.
This summary deals with what the end of these emergencies mean to employer health plans. Although Medicare, Medicaid and CHIP are mentioned, this is because of possible tangential effects on employer health plans.
While researching these provisions, some situations appear to be in flux. Expect clarifications to be made if any of the following are materially changed.
1. COVID-19 diagnostic testing:
Employer health plans will no longer be required to cover COVID-19 diagnostic testing (including over-the-counter tests) at no cost.
2. COVID-19 vaccinations:
Health plans may impose cost sharing if a participant gets a vaccine from a provider that is not in the participant’s employer health plan’s network. (The Affordable Care Act allows health plans to require cost sharing of out-of-network preventive services.)
3. Deadlines for key health benefit decisions:
During the national emergency, many employer health plans were required to give participants more time to make key decisions regarding employer health coverage.
For example, participants and family members had more time to request a special enrollment to join employer health plans. Also, more time was allowed regarding electing and paying for COBRA continuation coverage, as well as submitting appeals to employer health plans.
For these events or circumstances, relief will continue for 60 days after the end of the public health emergency (July 23, 2023). After this date, it appears employer health plans may revert to their original timeframes.
Interestingly, Questions and Answers published by the DOL emphasize that “…nothing in the Code or ERISA prevents a group health plan from allowing for longer timeframesfor employees, participants or beneficiaries to complete these actions, and group health plans are encouraged to do so.”
So it is possible some employer health plans may allow for longer timeframes than those required by law.
During COVID-19 public health emergency, many employer health plans expanded coverage of telehealth services. These provisions may change now the emergencies are over. Medicare will continue to keep in place telehealth services until December 2024.
5. Medicaid and CHIP Coverage:
Coverage through Medicaid or the Children’s Health Insurance Program (CHIP), may end as states are able to resume Medicaid and CHIP eligibility reviews.
6. Doctor Visits:
During the pandemic, rules requiring patients to see a doctor to be prescribed controlled substances such as Adderall and Buprenorphine were waived. That being said the DEA proposed new regulations on when doctor visits would be required for the prescription of certain controlled substance as follows:
“The Drug Enforcement Administration (DEA) has proposed, but not finalized, rules allowing buprenorphine for opioid addiction, testosterone for gender-affirming care, or ketamine for depression, an initial 30-day supply via telemedicine.” However, a doctor’s visit would be required to refill these prescriptions. Prescriptions for Adderall and Oxycontin would require a doctor visit.
Due to push back from Congress and the general public, the DEA has extended pandemic rules until it finalizes new ones. At some point, the DEA will publish new regs setting parameters around prescriptions and when doctor visits are required.
–U.S. Department of Labor Blog, “Five Important Changes to Your Health Coverage Once the COVID-19 Public Health Emergency Ends” March 29, 2023
–Questions and Answers published by Department of Labor (DOL), Health & Human Services (HHS) and the Treasury, March 29, 2023
–POLITICO Pro, “What Goes Away When the Covid Health Emergency Ends this Week.” May 8, 2023
–All Things HR, “Federal Court Blocks Enforcement of Some ACA Preventive Health Services Requirements: What Plan Sponsors Should Consider.” Dickinson Wright, May 9, 2023
–SHRM, “Early End to National COVID-19 Emergency Won’t Change July 10 Deadline.”More Ideas