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On Monday, January 30, 2023, the Biden Administration announced that it will end COVID-19 emergency declarations on May 11, 2023. This comes on the heels of the most recent PHE extension, effective January 11, 2023, which was extended until April 11, 2023. HHS indicated that a 60-day notice will be announced prior to the termination of the PHE. Additionally, CMS has indicated that they will provide instructions near that 60-day notice of termination that will guide suppliers regarding the policies and waivers directly affected by the PHE.

There are several provisions which impact our industry that are tied to the duration of the PHE that will remain in place due to the extension of the PHE, including: 

  • Medicare’s 75/25 blended rates for non-rural, non-CBA areas (these increased reimbursement rates will no longer end immediately when the PHE is ultimately declared over)
  • COVID-19 testing at no cost to the patient 
  • Waivers of certain telehealth restrictions 
  • Waivers related to Medicare medical policies (LCD) 

In preparation of the PHE expiration, there are some actions providers should take to related to claims submission and reimbursement, including:

  • Run reports to look for claims that are still being submitted with the CR modifier and “COVID-19” in the claim narrative.
  • Be familiar with the patients living in the non-rural, non-CBA areas because these areas will be affected by the reimbursement rates changing (that decrease in reimbursement will likely happen at the end of 2023).

At this time, CMS has not published any additional information to accompany the President’s announcement. Our team will continue to monitor and share as information is available.