Returning to "Normal": The End of the COVID-19 Public Health Emergency

The COVID-19 public health emergency (PHE) will officially end on May 11, 2023, signaling the return to the pre-pandemic “normal” and the application of the asterisk (*) next to calendar years 2020 to 2023 when performing data analytics. Since January 31, 2020, when the Secretary of the Department of Health and Human Services (HHS) declared the PHE, and March 30, 2020, when the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule in response to the COVID-19 pandemic, healthcare providers have been working under many waivers and extensions that softened regulatory guidelines.  

But before we look at what’s ahead, let’s first take a step back. When a PHE is declared, it is enacted for 90 days and can be renewed as necessary. Additionally, the HHS Secretary can also adjust the PHE length to be shorter than 90 days if needed. Since January 31, 2020, the COVID-19 PHE has continually been extended; however, on January 30, 2023, it was declared to end on May 11, 2023. This timing provides the required 60-day notification to state governors to prepare for the end of many of the COVID-19-related waivers and extensions. It also means that cancer programs and practices, as well as their providers, must prepare to return to “normal” or pre-pandemic practice standards.

Where to Go for Help Post-COVID-19 PHE

Due to the volume of changes enacted over the last few years, CMS has updated its website to provide direction on the policies and processes that are ending, changing, or remaining. One CMS resource, “Coronavirus Waivers & Flexibilities,” includes fact sheets by medical setting or entity type. For example, there are separate documents for physicians and other clinicians, hospitals, and CAHs (critical access hospitals, teaching hospitals and teaching physicians, and hospice). On February 13, 2023, CMS also updated its telehealth list, removing the column that identified the expiration dates of non-permanent telehealth services.  

Originally outlined in the Consolidated Appropriations Act of 2022, all telehealth services and many waivers and extensions were supposed to continue for 151 days after the COVID-19 PHE ended; however, the Consolidated Appropriations Act of 2023 made changes to telehealth. Specifically, changes to non-permanent waivers and extensions—that were enacted by CMS over the last three years—will occur on one of three dates: May 11, 2023, December 31, 2023, or December 31, 2024. 

To better understand what will be changing or ending and when, listed below are many of the primary waivers and extensions that impact oncology providers. Note: this is not a comprehensive list, and I recommended healthcare professionals visit the CMS website for additional information.

Waivers and Extensions That Will End or Change on May 11, 2023

• Virtual check-ins and e-visits for new patients will no longer be allowed; these visits will only apply to established patients. Healthcare Common Procedure Coding System (HCPCS) codes G2010 and G2012 (for physicians), as well as G2251 and G2252 (for non-physician practitioners), for remote evaluation of patient video/images and virtual check-in services can only be provided to established patients.  
• Telehealth via any non-public facing application. Telehealth visits will continue until December 31, 2024; however, the technology used to conduct a visit must be HIPAA compliant beginning May 12, 2023.    
• State laws will continue to govern whether a provider needs to be licensed in the state in which they practice. There is no CMS-based requirement that a provider must be licensed in their state of enrollment.
• Telemedicine services furnished to a hospital’s patients through an agreement with an off-site hospital will end.
• If a beneficiary’s home was designated as a provider-based department of the hospital for purposes of receiving outpatient services paid under the Hospital Outpatient Prospective Payment System (HOPPS), this designation will end.
• The process of allowing the addition of services to the Medicare Telehealth Services List on a sub-regulatory basis will end. Any requests for services to be added must be done through the rulemaking process. 
• Subsequent inpatient visits provided via telehealth, without the limitation of the telehealth visit being once every three days (Current Procedural Terminology [CPT®] codes 99231-99233), will end.
• Teaching physicians, who are only in residency training sites located outside of a metropolitan statistical area, may direct, manage, and review care furnished by residents through audio/video real-time communication technology.
• The locum tenens provision to provide coverage longer than 60 consecutive days during the PHE, whether the arrangement is reciprocal billing arrangements or fee-for-time compensation arrangements, will revert to the original guidelines. On the 61^st day after the PHE ends, the regular provider must use a different substitute (locum tenens) provider or return to work at their practice. 

As the PHE response to the COVID-19 pandemic continues to winddown, oncology providers will need to review the various extensions and waivers they implemented throughout the last three years. It is possible that some providers have already reverted to delivering care and services as they did pre-pandemic. For those who are still providing telehealth services, it is extremely important to review CMS’ varying phases of change to provide a smooth transition for patients and staff. 

For now, CMS is limited in the changes it can enact. Any provisions defined by Congress can only be changed by Congress. If Congress does not address what has yet to be outlined, then CMS will move forward with its changes or endings as defined within the Medicare final rules. Providers should find out what CMS proposes and finalizes for calendar years 2024 and 2025, including how any of these changes could impact their oncology services.

Teri Bedard, RT(R)(T), CPC, is executive director, Client & Corporate Resources at Revenue Cycle Coding Strategies in Des Moines, Iowa. Read Bedard's full report on what is expected to end or change on December 31, 2023, or December 31, 2024, in the upcoming Oncology Issues.