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When the Public Health Emergency (PHE) ends, so do the relaxed guidelines for health insurers, Medicaid, and states. But it may not be so easy to transition back to pre-pandemic requirements. So, what can health insurers expect in the coming weeks and months? We dove in deeper to find out more about the timelines, the industry predictions, and the potential impacts insurers should be prepared to embrace. There’s no question; we’re all excited for things to get back to normal. But there is still some anxious anticipation about the “how,” especially for insurance companies.

An End to Health Insurance Portability & Accountability Act Pandemic Provisions

Effective April 21 of this year, the Secretary of Health and Human Services authorized another PHE extension. Since its declaration in January of 2020, the Public Health Emergency has been extended several times. Along with those PHE extensions, health insurance providers also enjoyed relaxed HIPAA requirements.

HIPAA concessions became available during the PHE to authorize non-traditional engagements as necessary. Many of the strict formalities within the policy were relaxed to accommodate the challenging times associated with COVID-19 cases, therapies, and co-morbidities. With the end of the PHE around the corner, clinicians and state officials are wondering if those concessions will expire, as well. Some sources warn that entities should be prepared to see the end of temporary benchmarks for state licensing, commercial insurance, and flexibilities at different times but within conjunction with the expiration of the federal PHE.

What Will Become of the Telehealth Movement?

When CMS and Congress relaxed some of their rules, they included temporary expansion of telehealth services. In an attempt to allow certain flexibilities in coverage for virtual healthcare engagements, CMS was hopeful many of the rural and at-risk communities could benefit. And countless physicians, hospitals, and clinics jumped on board, adopting telehealth platforms to continue caring for their patients in a reduced risk environment. But now that the PHE is winding to an end, what will become of these vastly popular telehealth services?

Before the PHE, there were roughly 15,000 fee-for-service Medicare telemedicine service beneficiaries, according to CMS data. Limited coverage options and a lack of availability and promotion resulted in telehealth not being an options for many before COVID. The pandemic brought new needs, and since the PHE, CMS says it added 144 telehealth services to the approved roster. Emergency room visits, discharge management, nursing home care visits all became approved for Medicare coverage. And in more recent reports, of the 63 million enrollees in Medicare, more than 24.5 million of them engaged in telehealth services.

The Trump administration pushed to make the relaxed telehealth provisions more permanent. And while the request received wide support, there were some policymakers concerned about the long-term impacts of virtual health services. And the American Telemedicine Association (ATA) weighed in with sentiments suggesting that the temporary expansion of flexibility with telehealth coverages is important, but more than some of those provisions would likely need revising before transitioning to a permanent solution.

When the PHE ends, many industry experts are suggesting there won’t be a decline in the need for telehealth services. While the health risks associated with the pandemic may no longer be as prevalent, there will continue to be a need for telemedicine for rural patients, individuals with inadequate transportation, and those with conditions that make it more difficult to physically attend their appointments. Telehealth services also helped to bridge the gap in healthcare inequities across disadvantaged populations. And many advocates of the expansion of telehealth coverage argue that the broadened availability of phone, video, and electronic engagements only enhances patient care since more people participate with the convenient channels for services.

The Ending of the PHE May Vary by State

Health insurers need to be aware of their particular state regulations before making any sudden policy coverage changes. The PHE will end, but some states have different end dates based on varying effects of the pandemic among the residents. Some state officials are already dreading the end because it may signify less revenue and more work for Medicare health coverage.

When the PHE is over, the federal funding from the COVID-19 relief bills and relaxed benchmarks for enrollees during the pandemic will also end. States will also be responsible for reassessments to verify the eligibility of those currently enrolled. Every state will face a different path forward, but most officials are already requesting assistance from Washington to help them prepare. A smooth transition from pandemic conditions to post-pandemic normalcy will require in-depth planning and execution with the support of the federal level agencies.

In addition to the public health variances, states are also facing unique economic challenges. Some are encountering financial hardships as budgets deplete. Significant declines in statewide revenue will present more long-term challenges as states look to return to normal operations. Add to these conditions, the thousands of residents still facing lost income and work, states will still face varying needs for health insurance coverage options, likely putting a strain on available resources. As a health insurer, knowing what challenges your operating states face is critical in knowing how your organization should proceed post PHE.

As an example, Illinois introduced a bill, joining several other states in the push to make telehealth permanent and to remove reimbursement limits. This bill passed in Congress last April and officially passed the House in May. Supported by the Coalition to Protect Health, comprised of 36 healthcare and patient advocacy members, this bill makes telehealth coverage permanent and removes geographic restrictions for reimbursements after the PHE officially expires.

As a health insurer, the eventual end of the PHE is inevitable. And the best way to prepare is to understand your market, including your operating states’ initiatives and deadlines. And when you’re ready to leverage integrated cloud solutions that provide eligibility, enrollment, billing, reporting, and communications solutions, contact Softheon!