In April, we featured a post discussing the healthcare license waivers and portability during COVID-19.   While on the cusp of a new public health emergency extension, let’s review when the new extension takes effect, how our country prepares for and declares a PHE, and the latest waiver sanctions and flexibilities announced by our government authorities and local healthcare providers. 

A Third Public Health Emergency Extension

Secretary of Health and Human Services, Alex M. Azar II, officially extended the U.S. COVID-19 public health emergency declaration (first announced on January 31, 2020) for a continued 90 days ahead of the October 23 deadline. Under the Public Health Service (PHS) Act, Azar prolonged the extension from previous renewals on April 21, 2020, and July 23, 2020. The original declaration declared that a public health emergency exists and has, indeed, existed since January 27, 2020. 

Public Health Emergency Preparedness

Public health emergency preparedness continuously changes and adapts to prepare for, respond to, and recover from new and emerging threats and emergencies. After the 2001 World Trade Center and anthrax attacks, it became present that there was a need for a public health emergency preparedness infrastructure. As a result, Congress funded the Public Health Emergency Preparedness (PHEP) program in 2002. This program helped build state and local public health emergency preparation measures. 

In 2011, a need to improve public health emergency management arose. In response, the CDC published the Public Health Preparedness Capabilities: National Standards for State and Local Planning (2011) and introduced guidelines for the PHEP cooperative agreement. Furthermore, in 2018, the CDC updated the capability standards to advance state, local, tribal, and territorial preparedness. 

Since 2001, the U.S. has been faced with various hurdles, such as 9/11 and the anthrax attacks, hurricanes, flooding, an influenza pandemic, outbreaks of Ebola, and Zika virus, California wildfires, and now the Coronavirus. With every challenge, we have continued to learn more about stabilizing our preparedness level to keep our communities secure and sound. 

Declaring a Public Health Emergency

Under section 319 of the PHS, the Secretary of Health and Human Services can determine that:

  1. A disease or disorder presents a public health emergency (PHE)
  2. That a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists

Before issuance of the declaration, public health officials should be consulted, and Congress, the Department of Homeland Security, Department of Justice, and Federal Bureau of Investigation, must be informed within 48 hours. 

According to the U.S. Department of Health & Human Services, when the Secretary declares a PHE, he can take numerous appropriate actions. One of those actions is the capacity to grant extensions and waive sanctions when public or private entities cannot comply with deadlines due to the PHE. 

The following discusses some of the waivers and flexibilities granted during the Coronavirus pandemic.

COVID-19 Waivers and Flexibilities 

Since the onset of COVID-19, the current administration has issued many temporary regulatory waivers and flexibilities to equip our healthcare system better. 

The goals of these actions are to: 

  1. Expand our healthcare system workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the community or other states. 
  2. Ensure that local hospitals and health systems can handle a potential surge of COVID-19 patients through temporary expansion sites.
  3. Increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home.
  4. Expand in-place testing to allow for more testing at home or in community-based settings
  5. Put Patients Over Paperwork to give temporary relief from many paperwork, reporting, and audit requirements so providers, health care facilities, Medicare Advantage, and Part D plans, and States can focus on providing needed care to Medicare and Medicaid COVID-19 patients.

Medicare Telehealth & Virtual Visits

To decrease the Coronavirus spread, clinicians are increasing their offering of patient telehealth services and virtual visits. Under the PHE, all U.S. beneficiaries can receive Medicare telehealth and other communications technology-based services wherever they’re located. These services, as you know, are offered to new and existing patients. Remember that healthcare providers can waive Medicare copayments for such telehealth and other non-face-to-face services under Original Medicare.

CMS is regularly modifying the process to add services to the Medicare telehealth services list and, instead, will consider continuing relevant services as you request them. Medicare telehealth services must be provided through the use of audio/visual technology. CMS includes a complete list of all Medicare telehealth services on its website.

In-State Licensing Requirements for Healthcare Professionals 

While provider licensure requirements are regularly set at the state level, states under the PHE are adjusting these specifications. CMS is temporarily waiving Medicare and Medicaid’s requirements that physicians and other healthcare professionals be licensed in the state where they’re providing care for reimbursement purposes.  

To be considered for reimbursement, providers:

  • Must be enrolled as a provider in the Medicare program
  • Must possess a valid license to practice in the state which relates to the Medicare enrollment
  • Must be providing services in a state in which the emergency is occurring
  • Must not be affirmatively suspended from practice in the state or any other state that is part of the 1135 emergency area.

In addition, CMS is implementing actions to reform the provider enrollment process. The agency has committed to advancing any pending or new provider applications and postponing all revalidation actions.

Provider Organization Waivers

The following waivers and flexibilities help to ensure that providers receive the proper reimbursement for administering care during this time: 

  • Waiving 3-day prior hospitalization rule for coverage of a skilled nursing facility (SNF) stay
  • Waiving 25-bed requirement to classify as a critical access hospital and that the length of stay be limited to 96 hours
  • Allowing acute care hospitals to house acute-care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient
  • Waiving the 60-percent rule for inpatient rehabilitation facilities
  • Permitting long-term care hospitals to exclude patient stays from the 25-day average length requirement if the admit or discharge is ordered due to the emergency
  • Relaxing standards for lost, destroyed, irreparably damaged, or otherwise unusable durable medical equipment, prosthetics, orthopedics, and supplies

COVID-19 Hospitalizations

CMS has highlighted Medicare coverage and payment for COVID-19 services. In addition to coronavirus diagnostic tests covered by the new billing codes, traditional Medicare also covers medically required hospitalizations, as well as brief virtual check-ins.

The CARES Act

One other item that needs to be mentioned is The CARES Act. According to the U.S. Department of the Treasury, “The CARES Act provides fast and direct economic assistance for American workers and families, small businesses, and preserves jobs for American industries.” To summarize, Congress passed The CARES Act on March 27, 2020. This $2 trillion relief package is a commitment made by the current administration to protect Americans from COVID-19. 


Resources in Response to COVID-19

View all COVID-19 Resources