Published in Government Relations on January 11, 2023
On Wednesday, Jan. 11, 2023, HHS Secretary Xavier Becerra announced an extension of the COVID-19 Public Health Emergency (PHE). This extension will last another 90 days from January 11. PHE declarations, and subsequent extensions such as this one, only last for 90 days at a time but can be further renewed as many times as necessary.
What PHE Extension Means For DMEPOS Suppliers
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)
Remember, the competitive bid areas (CBAs) continue with the existing payment methodology, known as the single payment amount (SPA); the PHE extension does not affect payments in these areas.
Reimbursement rates are determined based on the beneficiary’s permanent address on file with SSA.
The next reconsideration for the PHE renewal will occur in April 2023.
While the PHE has been renewed for another 90 days, it would be a suitable time for suppliers to begin preparations for the PHE to be terminated. This means running reports to look for claims that are still being submitted with the CR modifier and “COVID-19” in the claimed narrative. Also, 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). We do know that HHS Secretary Becerra has stated that a 60-day notice will be announced prior to the termination of the PHE. We also know CMS will provide instructions near that 60-day notice of termination that will guide suppliers regarding the policies and waivers outlined above after the PHE has expired.