Post-COVID Medicare and Medicaid: Rules Matter

How many times have we panelists talked about COVID and COVID exceptions to the regulatory rules? How many times have we warned providers that the exceptions will expire at the end of public health emergency (PHE)?

Well, it’s coming. As Dr. Ronald Hirsch said, the COVID PHE is still in effect for the United States, but some states have lifted their PHE status. North Carolina’s state of emergency expired August 15, 2022. In Montana, the state of emergency ended June 30, 2021.

What does that mean? When America’s PHE expires, so do also all the exceptions. When your particular state’s PHE ends, so do the PHE exceptions your particular state allowed. This is imperative to all Medicare and Medicaid audits by whatever agency is knocking on your door. As well you know, auditors don’t always get it right. Add in confusion due to COVID exceptions and which exceptions apply in which state and which have expired? Things can get hairy fast.

Last week, the Centers for Medicare & Medicaid Services (CMS) released fact sheets summarizing the status of Medicare and Medicaid COVID waivers and exceptions by provider type. The fact sheets include information about which waivers and flexibilities have already been terminated, have been made permanent or will end at the end of the COVID-19 PHE. Unless specifically stated, all exceptions expire at the end of PHE, which is in the process of winding down.

I decided to review a fact sheet to determine how useful it was. I chose for provider type – hospitals. The 28-page fact sheet is entitled, “Hospitals and CAH (including swing beds, DPUs), ASCs and CMHCs.” The fact sheets are must reads for all providers. When you play chess, the rules matter. When you accept Medicare and/or Medicaid, the rules matter. And these fact sheets are the rules.

The fact sheets cover telehealth and reimbursement rates. The hospital fact sheet covers hospitals without walls, off-site patient screening, paperwork requirements, physical environment requirements, which waivers will or will not expire at the end of PHE, and much more.

I would say these fact sheets—for whichever type of provider you are — are mandatory reads. The fact sheets may not be absolutely encompassing, but they are summaries for you, all in one spot, organized for ease of reading. Thank you, CMS, for gathering this info and putting it all in one spot.

Programming note: Listen to healthcare attorney Knicole Emanuel every Monday for her exclusive RAC Report on Monitor Mondays, 10 Eastern.