Securing Temporary Public Payer Policies Following the PHE

As the public health emergency (PHE) nears an end, policymakers must consider expanding temporary public payer policies that improve person-centered care for beneficiaries, including telehealth and Medicare Advantage benefits, according to an issue brief prepared by Manatt Health and Health Management Associates (HMA) for the SCAN Foundation.

Since the start of the COVID-19 pandemic, CMS has implemented Medicare and Medicaid regulatory flexibilities that helped improve access to care for beneficiaries. These flexibilities removed financial barriers to care, expanded certain program eligibility, and allowed easier access to virtual healthcare services.

However, policymakers quickly enacted the flexibilities to ensure timely access to care when the pandemic hit, which led to inevitable bumps in the road.

For example, there was uneven data collection on how the regulations impacted patient care and outcomes during the pandemic. The limited data showed that certain flexibilities, such as telehealth policies, may exacerbate care disparities if specific modifications do not accompany them.

Some regulatory flexibilities helped align Medicare and Medicaid program policies, making it easier for beneficiaries and providers to access and initiate care.

Many of these temporary regulations will end when the public health emergency ends on April 15, 2022. Policymakers must decide which Medicare and Medicaid flexibilities to make permanent and determine any adjustments needed to improve patient-centered care.

Leaders should consider expanding telehealth benefits past the end of the PHE, Manatt Health and HMA said. Telehealth has increased access to care, especially for people who cannot leave their homes or face other barriers to in-person care. Virtual care has also helped boost access to specialty care, including behavioral healthcare.

However, to ensure equal access to telehealth, policymakers must pair virtual care regulations with policies that boost access to broadband and technology, the brief noted. Additionally, policies should include coverage for audio-only telehealth, as the care modality is popular among individuals who may not have access to devices with video capabilities.

“The permanent expansion of telehealth benefits for both Medicare and Medicaid would result in greater program alignment and reduced administrative complexity for providers and health plans,” the brief stated. “It also signals to providers and health plans that they can safely invest in long-term capabilities and potentially develop innovative care models that capitalize on the widespread availability of telehealth.”

Furthermore, policymakers should permanently allow telehealth in urban locations and home settings to continue telehealth access for Medicare beneficiaries and implement telehealth and in-person visits reimbursement parity. Medicaid should expand the utilization of state plan and HCBS benefits, the brief added.

The brief also suggested that leaders make Medicare Advantage telehealth policies permanent while being sure to include regulation that supports equal access.

“Allowing MA organizations to expand telehealth and other midyear benefit enhancements ensured that the approximately 40 percent of Medicare beneficiaries enrolled in an MA plan had the opportunity to use telehealth like their [fee-for-service] counterparts,” researchers wrote.

Policymakers should adjust the regulations that state which providers can provide Medicare and Medicaid services. The temporary flexibilities during the PHE helped maintain continuity of care and consumer choice, Manatt Health and HMA stated.

Increasing reimbursement rates also helped maintain care, although industry leaders need more data on how this impacted quality of care.

Expanding provider scope of practice would help align the Medicare and Medicaid programs, alleviate staffing shortages, and improve network adequacy, according to the brief.

Finally, policymakers should consider waiving the Medicare three-day prior hospitalization requirement for skilled nursing facility stays, expanding opportunities for self-directed HCBS under Medicaid, and implementing less restrictive income rules for individuals most likely to use long-term services and supports.