COVID-19 Emergencies to End

February 20, 2023

The COVID-19 National Health Emergency and Public Health Emergency (PHE) were to expire on March 1 and April 11, 2023, respectively. The Biden Administration is extending the expiration date to May 11, 2023, to align with its commitment to give a minimum of 60 days' notice prior to the end of the emergencies. Group health plans and issuers are studying what this means for medical plan related coverages and processes.

National Health Emergency

Under the National Health Emergency rules, deadlines for specific events are extended and a separate tolling period for each event is applied and these extensions will soon cease. Currently, tolling periods are the lesser of an additional one year after the event’s deadline or 60 days from the end of the National Health Emergency, which we now know is July 10, 2023.

Tolling periods apply to:
• The 30-day or 60-day HIPAA Special Enrollment period, such as the addition of a new spouse or newborn child
• The 14-day period to offer coverage to newly eligible COBRA beneficiaries
• The 60-day election period for COBRA initial enrollment
• The 30-day period to pay COBRA premiums
• The 60-day notification period for a COBRA beneficiary to notify a plan of a qualifying event or determination of disability
• The claims and appeal submission timeframes as provided by plans
• The time frame to request an external review or provide information that would perfect an external review

Public Health Emergency

Prescribed and over the counter COVID-19 tests are covered under the PHE rules, but the end of the emergency may signal that over-the-counter tests will no longer be covered under group health plans and insurance policies and prescribed tests may include a member cost share amount. Under the category of preventive care, vaccines for the coronavirus will continue to be covered at 100% without member cost share.

It is uncertain to what extent telehealth benefits may be affected by the end of the Emergencies. It is also unknown if an HDHP can maintain its qualified plan status with the IRS, while providing telehealth services without cost sharing prior to meeting the plan deductible, after July 10, 2023, or if this be allowed to continue for the remainder of the plan year.

What Occurs Next

Additional public and industry communications are anticipated. WebTPA will follow all updates and the effects on the plan’s processes administered by WebTPA and your plan members. We will share additional details as we acquire more information and develop an action plan for addressing the end of the Emergencies within the next few weeks.

Departments Suspend Surprise Medical Billing Independent Dispute Resolution (IDR) Payment Determinations

Since the No Surprises Act became effective on January 1, 2022, several disputes have arisen that challenge the weight given to the Qualifying Payment Amount (QPA) in the Independent Dispute Resolution (IDR) process. The 2021 Interim Final Rules related to the IDR process were jointly issued by the DOL, HHS and IRS. The Texas Medical Association sued, resulting in a federal trial court invalidating those portions of the regulations that instructed certified IDR entities to prioritize the QPA over other factors when determining the payment amount to providers. When the agencies finalized the IDR portion of the regulations, they removed the invalidated provisions and directed IDR entities to select the payment offer that best represents the value of the service, after considering the QPA and all information submitted by the parties. The Association then challenged the final regulations asserting that the regulations still give too much weight to the QPA in the dispute process. The same federal trial court vacated the final regulations February 6, 2023.

In response to the February 6, 2023, decision, the Departments of Health and Human Services, Treasury and Labor have directed certified IDR entities to not issue any new payment determinations until they receive further guidance from the Departments. In addition, payment determinations issued after February 6, 2023, are to be recalled by the certified IDR entities.

The hold placed on future IDR payment determinations does not affect the surprise billing processes leading up to the IDR payment determinations. The Qualifying Payment Amount (QPA) will continue to be calculated and paid for those claims eligible for surprise billing protections, as well as the open negotiation and initial IDR steps between providers and health plans. The Departments are in the process of evaluating and updating the federal IDR process guidance, systems, and related documents to make them consistent with the court order but does not provide a timeline for the updated guidance. For additional information, please access the CMS article here