AHA Wants Extension of Emergency Declaration, COVID-19 Flexibilities

Healthcare providers will still need key COVID-19 flexibilities beyond the end of HHS’ public health emergency declaration on July 25, 2020, the American Hospital Association (AHA) recently told top health officials.

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In a June 19th letter to HHS Secretary Alex Azar, the association called for an extension of the public health emergency declared on Jan. 31, 2020 “so health care providers can continue to offer the most efficient and effective care possible during the continuing COVID-19 pandemic.”

“That declaration has proven critical in equipping hospitals and health systems with the tools and resources necessary to manage the COVID-19 surge and ensure high-quality care in this unprecedented environment,” the AHA wrote.

In conjunction with President Trump’s national emergency declarations, HHS has been able to offer regulatory and statutory flexibilities to healthcare providers impacted by COVID-19. Chief among the COVID-19 flexibilities granted included payment parity for telehealth services furnished to Medicare beneficiaries, allowance of temporary expansion sites for the treatment of a greater number of patients during the pandemic, and waivers of physician supervision requirements.

These COVID-19 flexibilities, and more, have been central to COVID-19 response efforts, allowing hospitals to “use the vital tools necessary to combat the pandemic,” the AHA said.

However, HHS does plan to sunset the flexibilities when the public health emergency ends next month, meaning hospitals may have to go without key reimbursement and workforce tools if a second wave hits the US.

The US recently reported the highest number of new COVID-19 cases since May 1, according to national news sources citing data from Johns Hopkins University. The data underscores the fact that US healthcare providers are still “operating in a COVID-19 environment, requiring continued assistance from the federal government,” according to the AHA.

“Remarkable progress in combatting this pandemic continues to be made and now is not the time to pull back, but rather reinforce the need for a strong response from America’s hospitals and health systems as we work through the coming months,” the association stated. “We are hopeful that one of the vaccine candidates currently in development will successfully complete all necessary trial phases; however, until we reach that moment, our members, with your continued assistance and waiver flexibility, will remain ready and prepared to manage any future COVID-19 surges.”

The AHA advised HHS Secretary Azar to continue to extend the public health emergency declaration until the country exceeds 500,000 COVID-19 tests per day and the number of positive tests should by equal to or fewer than 5,000 per day for a period of at least 14 days.

During that period, the number of patients in intensive care unit (ICU) beds should also be fewer than 5,000 per day and the number of deaths from COVID-19 should be fewer than 500 per day, the association stated.

Additionally, the healthcare supply chain should also be able to meet the increased demand for personal protective equipment (PPE) and for laboratory testing supplies and COVID-19 treatment medications, the AHA added.

When the criteria are met, hospitals and health systems will not need to rely on COVID-19 flexibilities as much to manage the surge and care of infected patients. But according to the letter, the AHA does not anticipate that to happen for at least another several months, if not another entire year.

Other industry groups are also urging HHS to make certain COVID-19 flexibilities permanent considering the long-term impact COVID-19 will have on care delivery.

The American College of Physicians, for example, recently asked CMS Administrator Seema Verma to maintain payment parity for telehealth visits delivered after the expiration of the public health emergency.

“This extension should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits,” the College stated.

Patients are accepting more telehealth care now that providers have rapidly implemented and optimized their virtual care options during the pandemic, and that could translate to long-term use of the services. In fact, a new survey from Doctor.com showed that 83 percent of patients expect to use telehealth after the COVID-19 outbreak dies down.

However, providers fear that they will not be able to meet demand for telehealth services without the COVID-19 flexibilities granted by HHS during the public health emergency. Top health officials and policymakers have hinted at more permanent policies with telehealth coverage moving forward, but neither HHS nor Congress has announced major changes beyond the emergency declaration.