Medicare Compliance & Reimbursement

Prepare now for the end of the PHE, experts warn.

With other issues dominating the federal healthcare landscape, you may have pushed COVID-19 to the backburner. But, the virus is still there, twisting and turning, and federal policies are still churning as the pandemic stretches into 2023.

If you’re updating your COVID compliance, add these five things to your checklist.

1. Feds Renew the PHE for a 12th Time

The Department of Health and Human Services (HHS) Secretary Xacier Becerra renewed the COVID-19 public health emergency (PHE) for a 12th time effective Jan. 11.

This latest update follows previous 2022 renewals on Oct. 13, July 15, April 12, and Jan. 14 and 2021 renewals on Oct. 18, July 19, April 15, and Jan. 7. Before that, former HHS Secretary Alex Azar renewed the PHE declaration in 2020 on Oct. 2, July 23, and April 21. The original PHE declaration was effective Jan. 27, 2020.

Reminder: PHEs are extended in 90-day increments per the requirements of Section 319 of the Public Health Services Act and allow for certain 1135 waivers and flexibilities related to various Medicare policies and regulations. Over the last three years, COVID has ebbed and flowed, but the PHE extensions have allowed providers to take advantage of the regulatory leniency and continue to care for patients, which has been a boon to the healthcare industry at large.

But: Even though a new COVID variant is on the rise, the PHE won’t go on forever, observers warn. “Senior Biden officials are targeting an end to the emergency designation for COVID as soon as the spring,” Politico reports. That would “mark a major pivot in the country’s battle with the pandemic,” the news outlet notes.

“Once it expires, some of the flexibilities that Congress and federal agencies have will end,” reminds Holland & Knight LLP in the law firm’s weekly H & K Health Dose blog.

However, the recent omnibus bill signed by President Biden on Dec. 29, 2022 does offer a little bit of wiggle room on Medicare coverage of telehealth services (see Medicare Compliance & Reimbursement, Vol. 49, No. 1). Additionally, the administration has promised providers some warning before it intends to end the PHE for good, according to a letter to state governors in 2021. “When a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination,” the letter says. Administration officials have repeated that pledge over time as well.

Heads up: You should also expect a bit of legislative wrangling as pandemic policy waxes and wanes, Holland & Knight say. “Scrutiny of the administration’s handling of the PHE is expected to increase as the House Republicans implement their healthcare oversight agenda.”

Review the PHE renewal at https://aspr.hhs.gov/legal/PHE/ Pages/covid19-11Jan23.aspx. Read the letter to state governors at https://aspr.hhs.gov/legal/PHE/Pages/Letter-to-Governors-on-the-COVID-19-Response.aspx.

2. Don’t Shirk on PRF Reporting

If you received payments of more than $10,000 via either the Provider Relief Fund (PRF) — General or Targeted — and/or the American Rescue Plan (ARP) rural distributions between July 1, 2021 and Dec. 31, 2021, it’s time to attest for Reporting Period 4 (RP4).

Deadline: You have until March 31, 2023, at 11:59 p.m. ET to submit your report, according to online PRF guidance from the Health Resources & Services Administration (HRSA). “Reporting must be completed and submitted to HRSA by the last date of the reporting time period,” cautions the agency in an Oct. 27 notice, the PRF Distributions and ARP Rural Distribution Post-Payment Notice of Reporting Requirements. “PRF and ARP Rural recipients that do not report or return funds within the respective reporting time period are out of compliance with payment Terms and Conditions and will be subject to repayment,” HRSA warns.

Remember: Recipients of PRF distributions and ARP payments “must only use payments for eligible expenses, including services rendered and lost revenues (up to the end of the public health emergency), during the period of availability,” the notice reminds. For RP4, payments had to be used by Dec. 31, 2022.

Looking ahead, HRSA also offered insight on future reporting periods, too. “Key updates include reporting guidance for ARP Rural funding recipients and the addition of reporting periods 5, 6 and 7,” the agency highlights. The new reporting periods will have deadlines of July 1, 2023, Jan. 1, 2024, and July 1, 2024, respectively, HRSA says.

More information and links to the portal, the notice, and resources are at www.hrsa.gov/provider-relief.

Bonus: If you think your PRF/ARP rural payments weren’t calculated correctly, you can go through the reconsideration process and ask for a review. The deadline for the RP4 reconsideration is Feb. 21, 2023. There are several steps involved, including a specific reconsideration request form and required documents. You can find the details at www.hrsa.gov/ provider-relief/payments-and-data/payment-reconsideration.

3. Expect Increased Scrutiny of COVID-19 and Add-On Tests

Your lab may utilize additional testing in tandem with COVID-19 tests, but the documentation must ensure the medical necessity of those extra labs, according to an HHS Office of Inspector General (OIG) report.

Details: Last December, OIG released a new report that showed labs billed Medicare Part B for “high levels of add-on tests alongside COVID-19 tests in 2020.” Furthermore, “this significantly increased the payments they received for claims that included COVID-19 tests,” OIG found.