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The Biden administration has announced its plan to end the national and public health emergency (PHE) of covid-19 May 11, 2023. Employer-sponsored health plans have been required to meet certain coverage requirements during the COVID-19 emergency periods, including the following:
- Health plans must cover diagnostic tests for covid-19 and related services without imposing any cost-sharing (such as deductibles, co-payments or co-insurance) under PHE; and
- Non-grandfathered health plans must cover certain preventive services, including recommended covid-19 vaccines and boosters, without cost sharing. Under PHE, this coverage mandate applies to covid-19 vaccinations provided by all providers, whether in-network or out-of-network.
Additionally, during the COVID-19 outbreak period (which is tied to the national emergency), certain health plan deadlines are being extended, including the deadlines for requesting special enrollment under HIPAA, electing COBRA continuation coverage, and following the plan’s claims and appeals procedures.
Impact on Health Plans
When PHE ends, health plans will no longer be required to cover diagnostic tests for covid-19 and related services without cost-sharing. Health plans will still be required to cover recommended preventive services, including covid-19 vaccinations, without cost sharing, but this coverage requirement will be limited to in-network providers. Additionally, once the COVID-19 outbreak period is over, health plans can go back to their unextended deadlines for HIPAA special enrollment, COBRA continuation coverage, and claims and appeals procedures.
Public health emergency
The US Department of Health and Human Services (HHS) first declared that a PHE exists due to the COVID-19 pandemic on January 31, 2020. A PHE declaration lasts for 90 days unless terminated early by HHS. At the end of the 90-day period, HHS may extend the PHE or allow it to expire. HHS has repeatedly extended the COVID-19 PHE since it began in early 2020. Most recently, HHS renewed the PHE on January 11, 2023. HHS has promised to give the public at least 60 days notice before the PHE’s end date.
On January 30, 2023, the Biden Administration announced its plan to end PHE on May 11, 2023. The Biden administration noted that it opposes proposed legislation that would immediately end the Covid-19 emergency periods, saying it would create chaos and uncertainty for the US health care system.
Health Plan Changes
When PHE ends, the following rules apply to the health plan’s coverage with the covid-19 pandemic will no longer apply:
- Diagnostic testing of covid-19 without cost sharing—Under PHE, health insurers and health insurers must cover covid-19 testing and related services without imposing any cost-sharing or prior authorization or other medical management requirements. As of January 15, 2022, this coverage requirement extends to diagnostic tests for covid-19 at home. Health plans and issuers will no longer be required to provide this first dollar coverage when PHE ends.
- Covid-19 vaccines— Out-of-Network Providers — Non-grandfathered group health plans and health insurers must cover preventive services for coronavirus, including recommended vaccinations against covid-19, without cost-sharing requirements. Under PHE, covered services may be provided by in-network or out-of-network providers. When PHE ends, health plans and issuers must continue to cover recommended COVID-19 vaccinations without cost-sharing but may limit this coverage to in-network providers.
- Cost of covid vaccine – Under PHE, the federal government subsidizes the cost of covid-19 vaccines, boosters, treatments and tests. This federal funding is running out and as the supply of vaccines purchased by the federal government runs out, plan sponsors will see an increase in costs.
- Stand-alone telehealth benefits— For plan years beginning under PHE, a large employer (more than 50 employees) may offer stand-alone telehealth benefits and other telehealth services to individuals who are not eligible for coverage under any other group health plan offered by the employer without violating the Affordable Care Act’s market reforms. These types of stand-alone arrangements will not be permitted after PHE ends.
- Eligibility for Medicaid — The Families First Coronavirus Response Act (FFCRA) included a requirement that Medicaid programs keep people continuously enrolled until the end of the month when the COVID-19 public health crisis (PHE) ends, in exchange for increased federal funding. The Consolidated Appropriations Act, 2023 (CAA) will end this provision (prior to the end of PHE) on March 31, 2023. States will begin phasing out Medicaid on April 1, 2023. Employers can expect an increase in enrollment after midterm. to loss of Medicaid.
National Emergency – Outbreak Period
Various deadlines related to employer-sponsored group health plans are being extended during the COVID-19 outbreak period. The outbreak period began in March 2020, when former President Donald Trump declared a national emergency due to the COVID-19 pandemic, and will continue until 60 days after the end of the national emergency for COVID-19 (or such other date as notified by the federal government).
On January 30, 2023, the Biden administration announced its plan to end the national emergency for covid-19 on May 11, 2023. According to this timeline, the eruption period will end it 10 July 2023.
During the outbreak period, some important deadlines for staffing plans and participants are extended. During the relief, these extensions of time expire when the outbreak period is over or, if earlier, after an individual has been eligible for a certain deadline extension for one year. Deadline extensions that apply during the outbreak period include the following:
- HIPAA Special Enrollment— The 30-day period (or the 60-day period for Medicaid and CHIP, if applicable) to request special enrollment.
- COBRA Notice and Premium Payment Deadlines— the 60-day period to elect COBRA coverage; the date to make COBRA premium payments (generally at least 45 days after the date of the first COBRA election, with a grace period of at least 30 days for subsequent premium payments); and the date for individuals to notify the plan of a qualifying event or disability determination (generally 60 days from the date of the event, loss of coverage, or determination of disability).
- Final claims and appeals— The deadlines for filing a benefit claim, appealing a negative benefit decision, or requesting an external review of a claim under the plan’s claims and appeals procedures.
Pre-deductible telehealth cover
In response to the COVID-19 pandemic, the Coronavirus Aid, Relief, and Economic Security (CARES) Act allowed high-deductible health plans (HDHPs) that are compatible with Health Savings Accounts (HSAs) to provide benefits for telehealth or other telehealth services on a pre-deductible basis. was fulfilled. This relief was not linked to PHE or the outbreak period; rather, it applied to plan years beginning before January 1, 2022. A spending bill expanded this relief to telehealth services for months beginning after March 31, 2022 and before January 1, 2023.
The Consolidated Appropriation Act, 2023 (CAA), which was signed into law on December 29, 2022, expands the ability for HDHPs to provide benefits for telehealth or other telehealth services before the plan’s deductibles have been met without jeopardizing HSA eligibility. Regardless of when the COVID-19 emergency periods end, HDHPs can be designed to waive the deductible for all telehealth services for plan years beginning in 2023 and 2024 without causing participants to lose HSA eligibility. This extension applies to plan years beginning after December 31, 2022 and before January 1, 2025. Non-calendar year plans will have a gap from January 1, 2023 to the beginning of the 2023 plan year causing a mid-year gap in eligibility for reduced or free telehealth before the deductible is met.
Action items and key takeaways
- COBRA – Amend COBRA election documents to inform eligible beneficiaries that the extensions no longer apply.
- HIPAA Special Enrollment – Plan administrators will no longer be required to fulfill mid-year requests to enroll new spouses or dependents after the 30- or 60-day time frames.
- Outbreak period deadlines – These time limit extensions end when the outbreak period is over or, if earlier, after an individual has been eligible for a certain one-year time limit extension. Deciding on which date a deadline should fall must be an individual analysis depending on the date of eligibility.
- Review/Change – review plan documents, policies, COBRA notices and other employee communications to ensure compliance with pre-pandemic regulations once the public health emergency and outbreak period ends.
- Summary of Material Changes (SMM) – the mid-year change can be considered a reduction in benefits that would require an SMM within 60 days of the change.
- Mental Health Parity and Addiction Equity Act (MHPAEA) – Plan sponsors should review covid-19 coverage and related costs to determine if any coverage will continue. However, continued coverage may cause problems with compliance with the MHPAEA.
Join us for a Q&A webinar on March 2, where we will discuss the decision to end these COVID-19 crisis periods and how this decision will affect employers in 2023.
How the end of covid-19 emergency periods will affect health plans
Thursday, March 2
10:00 in the morning