HHS Promises To Provide 60-Days Notice Before Sunsetting PHE

Inside Health Policy

December 17, 2021 8:24 pm

HHS won’t say how long it plans to extend the public health emergency declaration beyond mid-January, telling Inside Health Policyit will provide 60-days notice before letting the emergency and its related regulatory flexibilities lapse — making planning difficult for health care stakeholders navigating regulatory requirements and state Medicaid directors preparing to restart eligibility redeterminations paused during the pandemic.

However the guaranteed advance notice, meaning so far the PHE will last at least through mid-March, is relief to some providers who say it gives them a few more months to convince Congress to continue telehealth waivers post-PHE.

States receive a 6.2% bump in federal Medicaid matching funds (FMAP) if they keep Medicaid beneficiaries continuously enrolled throughout the public health emergency. States have one year after the PHE ends to resume reviewing Medicaid beneficiary eligibility, and the FMAP will expire at the end of the quarter that the PHE ends. Telehealth and other COVID-19 regulatory waivers also will expire with the PHE.

The Biden administration told states on Jan. 22 it would renew the public health emergency declaration through the end of 2021, then HHS Secretary Xavier Becerra last renewed the COVID-19 public health emergency for 90 days on Oct. 15.

“While we cannot forecast how long the SARS-COV-2 pandemic will continue to be a public health emergency, HHS remains committed to providing a 60-day notice to states before sunsetting related public health emergency declaration extensions,” an HHS spokesperson told Inside Health Policy in an email Thursday (Dec. 16).

The Congressional Budget Office predicted in July the PHE will last through July 2022, but the National Association of Medicaid Directors said this isn’t enough for some states to be able to plan.

“[W]hat the CBO assumes is not something that states can necessarily factor into their own budgeting assumptions, and the reasons for that is either states are required to operate that way under their own procedures or you don’t want to make an assumption that something will continue through a date and get that date wrong and expose the state to significant financial risk,” NAMD Director of Federal Policy Jack Rollins said.

State Medicaid directors appreciate the 60-day notice, but NAMD notes they need as much time as possible to prepare for the so-called unwinding of the public health emergency. States have to roll out information technology system updates, explain to beneficiaries about quickly changing eligibility rules and hire and train new staff. One state Medicaid director said about 40% of his staff have never done an eligibility redetermination before.

The uncertain path forward for the Build Back Better plan is another challenge for states. The House-passed version would decouple the continuous eligibility requirement from the PHE and phase out the 6.2% FMAP beginning March 31, 2022 instead of letting it expire at the end of the quarter the public health emergency ends.

While the reconciliation package provides the certainty Medicaid programs have pushed for, the timeline will be tight if Congress doesn’t pass the BBB plan until January or later, or not at all.

Meanwhile, the Medical Group Management Association was relieved to hear the administration will stick to its 60-day warning before letting the PHE expire.

“One of our concerns throughout the pandemic is that the ending of the PHE would cause a ‘telehealth cliff’ for many medical groups — we would like to avoid a situation where the rug is pulled from underneath practices that modified workflows and invested in the infrastructure to provide telehealth visits to patients,” MGMA Government Affairs Director Claire Ernst said in an email.

MGMA wants policymakers to permanently remove originating and geographic restrictions from the Medicare statute but also find ways to keep telehealth as a tool that does not disrupt patient care and maintains the patient-provider relationship.

“I am optimistic that 60 days is enough time to make these policies permanent — but that depends greatly on Congress’s ability to pass legislation to address these reforms,” Ernst added. “Telehealth reform is a bipartisan, bicameral issue — I hope that is enough to grease the wheels and get legislation passed quickly as to prevent a telehealth cliff.”