While in many ways it seems that the COVID-19 pandemic is over, there are still many special rules generated by the pandemic that directly or indirectly affect employers’ health insurance plans. In this article, we will answer some of the questions we receive from employer plan sponsors about the special rules that are still in place and how to prepare for the removal of these special rules.
What is the state of emergency in the country?
As we wrote earlier in the May 2020 and March 2021 articles, various deadlines associated with employer plans are being extended during the COVID-19 “outbreak period”. The outbreak period began in March 2020 when then-President Trump declared a national emergency over COVID-19 and will end 60 days after the end of that state of emergency, which is still in effect. As a reminder, below are some of the key deadline extensions:
- Extending the time limit for filing, appealing, or requesting an external review of a grievance.
- Extending the COBRA Choice Period, COBRA Payment Due Date, and COBRA Deadlines for Plan Notification of a Qualifying Event or New Disability.
- Extension of the 30-day or 60-day window for filing a special HIPAA registration request.
These extensions end at the end of the epidemic period (60 days after the end of the national emergency) or after any individual is eligible for any specific assistance for one year.
Are there any other emergency announcements that still affect our plans?
In addition to the national emergency, the Secretary of Health and Human Services (HHS) declared a public health emergency in January 2020 and has repeatedly taken steps to extend that declaration for 90-day periods. We remind you that the state of emergency in the field of public health is still in effect:
- Employer health insurance plans must cover the cost of COVID-19 diagnostic testing and related services without any contribution to member costs, prior authorization, or any other health care requirements. Effective January 15, 2022, this coverage has extended to over-the-counter (OTC) tests.
- Employers may offer a separate telehealth benefit that is not covered by the Affordable Care Act and other provisions that generally prohibit providing telehealth benefits to employees who are not also covered by the employer’s primary health insurance.
Are there any temporary rules still in place?
- The CARES Act allows pre-deductible telemedicine coverage for people with High Deductible Health Plans (HDHPs), including those linked to Health Savings Accounts (HSAs), until 2021. As discussed in detail in our April 2022 article, Congress acted to extend this special assistance by passing the Consolidated Appropriations Act (CAA) of 2022, but this extension is only valid from March 31, 2022 to December 31, 2022.
- The CARES Act required employers’ health plans to cover the cost of COVID-19 vaccines while the public health emergency was in place, a requirement that is now permanent as it has become a preventive service under Affordable Care Act rules that require first dollars of coverage for preventive services. care.
- During the pandemic, the federal government covered many of the costs associated with COVID-19 on behalf of the public, including the cost of the vaccines themselves and the purchase and supply of over-the-counter testing kits. These public health spending are likely to be temporary and may end when the national emergency and public health emergency officially ends, or shortly thereafter. This is important for employers’ health care plans because it would shift the financial burden of paying for vaccines and testing currently covered by the federal government onto employers’ plans.
When will these special rules end?
As of the date of this article:
- The national emergency will end on February 28, 2023 unless the White House takes action to extend or shorten it.
- The public health emergency will end on October 12, 2022 unless HHS takes action to extend that date.
- The HDHP/TeleHealth Regulation will expire on December 31, 2022, unless Congress decides to renew it.
HHS has indicated that they will notify the public at least 60 days before the public health emergency officially ends. We also expect the White House to give advance notice of the end of the national emergency. There is also talk that the White House and HHS could coordinate to end the public health emergency and the national emergency at the same time, but these are just speculations at this point.
Is there anything we should do to prepare for when these temporary provisions expire?
Most employer insurance plans have made formal and informal adjustments to their processes in light of the specific provisions noted above. However, even those employers who are on top of this may want to consider the following actions to prepare for the possible end of the easing periods:
- When the national emergency ends, the COBRA deadlines will again need to be met. Plans must ensure that all COBRA-eligible individuals who receive extensions in light of the waiver are properly identified in registration systems. This is important because from a fiduciary point of view, you will want to communicate the end date to affected individuals. In addition, the end date will not be the same for all individuals in the extended COBRA election or payment window, so it is important to keep track of all relevant dates.
- Employers that have offered free telehealth to HDHP members should assume that you will not be able to continue using free telehealth in 2023 and plan accordingly when preparing benefits for 2023.
- For those employers that have offered free telehealth to all employees, whether or not they are enrolled in your primary health plan, your planning should include the need to limit any free telehealth for employees enrolled in a non-HDHP primary health plan to 2023 if the Public Health Emergency ends this year and 2024 if it ends next year.
- Additionally, with regards to planning for 2023, employers may want to consider whether their health plan will continue to cover COVID-19 testing at no cost, or reimburse the cost of OTC COVID-19 testing when such coverage no longer required. in accordance with the law.
- When considering what coverage the plan will offer after the end of the various periods of COVID-19 assistance, the plan should consider that many departments have been impacted by the agency’s enforcement during the pandemic. For example, some Mental Health Equity and Addiction Equity Act (MHPAEA) enforcement efforts were chargeable during the pandemic if the plan covered non-cost-sharing items and services for COVID-19 testing. However, after the end of the public health emergency, such coverage may raise concerns about parity in evaluation under the MHPAEA.
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