End of the COVID-19 Public Health Emergency
The federal COVID-19 public health emergency declaration expired on May 11, 2023, resulting in changes to temporary measures that gave flexibility to providers and supported access to care during the pandemic.
Policy Changes Following the End of the COVID-19 Public Health Emergency
The federal COVID-19 public health emergency declaration expired on May 11, 2023, resulting in changes to temporary measures that gave flexibility to providers and supported access to care during the pandemic.
Some policies initiated under the authority of the public health emergency were extended or made permanent through laws or regulations. However, others ended after the deadline. Several of these policy changes may have implications for care delivery by plastic surgeons, particularly with regard to telehealth and other types of virtual services.
Telehealth and Virtual Services
The COVID-19 pandemic accelerated the adoption of telehealth among a variety of provider types. Plastic surgeons use telehealth for services such as initial preoperative consultations and routine postoperative visits for both cosmetic and reconstructive procedures, according to an American Society of Plastic Surgeons (ASPS) member survey.
In response to the pandemic, the federal government relaxed certain overarching requirements for telehealth and expanded coverage for telehealth provided to patients with Medicare. The status of policies most likely to affect plastic surgeons is discussed below. A 2020 ASPS Position Statement on telehealth and plastic surgery also offers specific considerations for plastic surgeons navigating this mode of care.
During the public health emergency, the Department of Health and Human Services (HHS) allowed providers to use any non-public-facing application to communicate with patients without risking federal penalties for noncompliance with the Health Insurance Portability and Accountability Act (HIPAA), regardless of whether the care was related to COVID-19. This leniency expired on May 11, but providers have an additional 90-day transition period to come into compliance. Thus, providers should ensure that the applications they are using to provide telehealth to patients are HIPAA compliant by August 9, 2023.
The Consolidated Appropriations Act (CAA) of 2023 extended many of the pandemic-era telehealth policies specific to Medicare beneficiaries through December 2024. For example, the CAA continues to waive geographic restrictions on the originating (patient) site for care through 2024, and Medicare beneficiaries may still receive telehealth services in their home. Before the pandemic, Medicare coverage of telehealth was limited to patients in designated rural areas and those who went to certain types of medical facilities to receive telehealth services.
The CAA also extends through 2024 the availability of certain telehealth services that can be delivered through audio-only technology. The Medicare Telehealth Services List specifies which services meet the requirements for audio-only interaction, and those that do not meet the requirements must be furnished through audio and video equipment that permits two-way, real-time interaction between the patient and provider. Telephone evaluation and management services are among those eligible to be provided via audio-only technology. Medicare will also continue to pay for telephone evaluation and management visits with established patients at the same rate as office or outpatient visits through 2024.
During the public health emergency, the Centers for Medicare & Medicaid Services (CMS) added a number of covered services to the Medicare Telehealth Services List. These added services will stay on the Medicare Telehealth Services List through the end of 2023, and CMS expects to update the list when proposing and finalizing the Calendar Year 2024 Physician Fee Schedule rule.
In addition, physicians could provide virtual services such as e-visits and remote physiologic monitoring to both new and established Medicare patients during the public health emergency. After May 11, these types of services may be provided only to established patients.
CMS also temporarily revised Medicare physician supervision requirements to allow the "virtual presence" of the supervising physician to provide assistance during the service via real-time audio and video technology. This flexibility will be available through the end of 2023.
The Office of Inspector General allowed providers to reduce or waive cost sharing for telehealth services delivered to beneficiaries of federal health care programs without being subject to administrative sanctions. This flexibility ended May 11, 2023.
Some telehealth policy changes for Medicare have already been made permanent through new laws and rules. Many of these enduring changes pertain to mental and behavioral health care. More information on temporary and continuing changes to Medicare telehealth policy is available at Telehealth.HHS.gov and in the following fact sheets: Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 and Frequently Asked Questions: CMS Waivers, Flexibilities and the End of the COVID-19 Public Health Emergency.
States determine requirements for physician licensure. According to HHS, all 50 states and Washington, DC, waived some components of their licensure requirements during the public health emergency, allowing more physicians to deliver telehealth in states where they are not licensed. Providers should be aware of potential state-level changes to these flexibilities as state public health emergency orders end.
During the public health emergency, providers registered with the Drug Enforcement Administration (DEA) could prescribe certain controlled substances (schedule II-V) via telehealth to patients without having conducted an in-person medical evaluation. DEA released a temporary rule extending this flexibility through November 11, 2023. However, if a practitioner and a patient have already established a relationship via telehealth under these flexibilities (i.e., the practitioner has prescribed controlled substances to the patient without an in-person visit) before November 11, 2023, the flexibilities continue to apply through November 11, 2024.
Providers should monitor these evolving requirements at the federal level and review any applicable restrictions in their state.
A host of other policies and programs initiated under the authority of the public health emergency and that have ended, been extended or made permanent may not directly affect plastic surgeons' practice but still may be of interest. For example, providers may want to explore the status of policies governing coverage of COVID-19 testing, vaccination and treatment; waivers designed to improve care capacity; and requirements for COVID-19 data reporting. Resources outlining these and other policy changes made in response to the public health emergency are available on the COVID-19 Public Health Emergency page of the HHS website.