PHE End Brings Changes for Telehealth, Billing, and Medicaid
By Emma Freer


The federal public health emergency (PHE) related to COVID-19 ended May 11 – and with it, several flexibilities related to telehealth coverage, virtual physician supervision of nonphysician practitioners (NPPs), and Medicaid enrollment for nearly 3 million Texans. 

The Texas Medical Association recently hosted two events to help guide physicians and their practices through this transition, which arrives after more than three years of operating under the emergency declaration and nearly a dozen extensions. 

Ask the Expert: End of the Public Health Emergency 

TMA experts addressed the looming telehealth and billing changes resulting from the PHE’s end during a recent Ask the Expert virtual event.  

Throughout the pandemic, state and federal governments relaxed regulatory and payment barriers to telehealth care. That included allowing the use of non-HIPAA-compliant platforms, paying for telemedicine visits at the same rate as in-person visits, and waiving geographic site restrictions that would normally require a patient to be seen in person. 

But these flexibilities are temporary, emphasized Shannon Vogel, TMA’s associate vice president of health information technology. 

“There are a lot of changes coming when the PHE ends,” she said during the event. 

Perhaps most notably, practices must use HIPAA-complaint telehealth platforms after May 11, with the federal government granting clinicians 90 days - until Aug. 9 - to come into compliance. To help physicians and their practice staff navigate these changing requirements, Ms. Vogel pointed to the following TMA resources:  

  • End of PHE Telehealth Chart, which details the various telehealth waivers implemented during the PHE and their varying expiration dates; and 
  • Telemedicine Vendor Options, which lists several telemedicine products and their key functions to help prospective shoppers.  

The end of the PHE also spells billing changes related to telemedicine payment parity and physician supervision of NPPs. 

Starting Jan. 1, 2024, Medicare will no longer pay for telemedicine appointments at the same rate as in-person visits, reverting instead to the facility rate.  

Carra Benson, TMA’s director of reimbursement services, said the association is monitoring commercial payers’ corresponding policies. But she noted facility rates “are typically lower than non-facility ones.” 

Also starting Jan. 1, 2024, Medicare will end virtual direct supervision and require the supervising physician to be in the same physical location as any NPP to whom he or she has delegated authority to qualify for full payment. 

But there are certain exceptions. For instance, Medicare will require general supervision, rather than direct supervision, when it comes to behavioral health care starting next year.  

Ms. Benson explained general supervision requires an NPP to provide any health care services under the physician’s overall direction and control. 

She also cautioned practices to consult individual commercial payers’ policies regarding physician supervision of NPPs, given that they will vary and may differ from Medicare’s.

In addition, the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration on May 9 issued a temporary rule extending PHE-related telehealth flexibilities for prescribing controlled medicines through Nov. 11, 2023. For patient-physician telemedicine relationships established by Nov. 11, 2023, these flexibilities will be extended for an additional year, through Nov. 11, 2024. 

Medicaid Unwinding 101: Preparing Your Patients and Your Practice

The PHE’s expiration also will impact Texas Medicaid patients and the physicians who care for them. 

Sugar Land pediatrician Cynthia Peacock, MD, recently moderated another TMA event, a webinar focused on how practices can prepare for the Medicaid unwinding process, with guest speakers from the Texas Health and Human Services Commission (HHSC), the South Texas Physician Alliance, and the Texas Association of Community Health Centers (TACHC).  

The federal Families First Coronavirus Response Act temporarily increased federal Medicaid matching dollars by 6.2% for states that agreed to maintain Medicaid for anyone enrolled in the program through the end of the PHE, including Texas. As a result, HHSC estimates roughly 2.7 million Texans have benefitted from continuous Medicaid enrollment since March 2020. 

But the continued coverage requirement ended March 31, and states are now in the process of redetermining Medicaid eligibility and disenrolling patients who no longer qualify.  

Molly Lester, HHSC’s deputy chief program and services officer, said during the webinar that this process will impact not only those who benefitted from continuous coverage but also everyone enrolled in Medicaid, totaling more than 5.9 million Texans, in line with federal guidance.  

HHSC has a three-phase plan for conducting Medicaid redeterminations. Although many Texans will remain eligible for the program, some will be disenrolled either because they no longer meet the eligibility criteria or because of bureaucratic barriers, such as difficulties navigating the renewal process or address changes.  

Harlingen family physician Sheila Magoon, MD, executive director of the South Texas Physician Alliance and a member of TMA’s Committee on Medicaid, CHIP, and the Uninsured, urged physicians to prepare their patients for this potential coverage cliff. 

“It’s really just important to let them know that Medicaid is changing … and that if they don’t respond [to Medicaid renewal packets or requests for information], that they can lose their coverage,” she said during the event.  

Dr. Magoon provided several examples of patient outreach, including: 

Using HHSC’s Ambassador Toolkit to access messaging, flyers, and social media graphics for in-practice use; 

Reassuring parents they can enroll their citizen children in Medicaid and the Children’s Health Insurance Program regardless of their own immigration status; and 

Reminding patients they will hear from HHSC and Texas Medicaid plans regarding their eligibility.  

Fortunately, the end of the PHE coincides with some recent policy developments, including increased federal funding for navigators – community organizations that connect eligible consumers to public and private health plans – and extended enhanced subsidies for those same plans. 

Helen Kent Davis, TMA’s associate vice president for governmental affairs, provided participants an overview of federal and state health care programs for which patients transitioning from Medicaid might be eligible, as well as local programs for those who will become uninsured.   

Daniela De Luna, TACHC’s deputy director of state affairs, also referred physician practices to:  

  • Stay Covered Texas, which includes resources for Medicaid patients as well as a mechanism for reporting eligibility issues; and 
  • TACHC’s search tool, which helps users find health center outreach and enrollment services.  

TMA is working making recordings of the two events available soon. Find all of TMA’s “Ask the Expert” virtual series events on the association’s website.  

Last Updated On

June 26, 2023

Originally Published On

April 12, 2023

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Coronavirus | Medicaid | Telemedicine

Emma Freer

Associate Editor

(512) 370-1383

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

More stories by Emma Freer