Payer Flexibilities Continue With COVID Emergency Extension

The U.S. Department of Health and Services’ extension of the federal COVID-19 public health emergency (PHE) until July 15, 2022, means many of the waivers that public and private payers instituted remain in place.

The extension of the PHE is the ninth combined under the Trump and Biden administrations since it was originally put in force on Jan. 31, 2020, retroactive to Jan. 27. 

Texas Medical Association experts say extensions of the PHE allow the Centers for Medicare & Medicaid Services (CMS) to maintain several COVID-19-related Medicare waivers and flexibilities, including paying the same rate for telemedicine visits as for in-person visits, and allowing use of audio-only telemedicine services.  

For Medicaid, the extension means Texas will continue to receive a 6.2% increase in federal Medicaid funding in exchange for maintaining coverage for people who enrolled on or after March 18, 2020, including women who otherwise would lose Medicaid 60 days postpartum.   

The extension also means private health insurers’ copayments related to COVID-19 testing (though not necessarily treatment) and related to any forthcoming vaccinations will be waived. The state Office of Public Insurance Counsel website includes each Texas insurance carrier’s COVID-19 cost-sharing policy. 

Certain HIPAA enforcement actions also will continue to be relaxed. Specifically, physicians who use certain telemedicine platforms in good faith will not be penalized for noncompliance.   

The Biden administration has said it will give 60 days' notice before ending the PHE.

Throughout the pandemic, TMA has called on state and federal leaders continuously to allow flexibilities and expand programs in an effort to protect practices financially. 

As always, check the TMA COVID-19 Resource Center regularly for up-to-date news and the latest TMA materials for your practice.

Last Updated On

April 21, 2022

Originally Published On

October 26, 2021

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