AAFP Calls for Comprehensive Plan on ‘Unwinding’ PHE

Academy Delivers Detailed Guidance to HHS, Other Agencies

June 23, 2022, 5:02 p.m. News Staff — With much of the U.S. riding out another COVID-19 infection surge and the most recent extension of the pandemic-driven public health emergency set to expire in mid-July, the Academy this month delivered urgent new guidance to federal regulators and called for the PHE to continue “through at least the end of calendar year 2022.”

“The AAFP strongly recommends HHS publish a comprehensive plan outlining all the existing flexibilities and policies that will change once the federal PHE declaration expires. HHS should offer the public at least 60 days to comment on this plan and should work with other departments, such as Treasury and Labor, to outline how it will minimize disruptions and address gaps in health care coverage and access.”

The message echoed guidance the Academy sent CMS last month, advocating for post-PHE policies to ensure Medicaid beneficiaries’ access to timely and comprehensive care — including primary care and behavioral health care — while addressing low Medicaid physician payment and burdensome administrative processes.

The June 17 letter likewise centered its detailed recommendations on ensuring continuous health care coverage and ongoing access to comprehensive care for patients following the PHE while urging the agency to consider “additional policy and programmatic considerations in its plan for transitioning out of the federal PHE.”

COVID-19 Vaccines and Treatments

Keeping COVID-19 at top of mind, the Academy began by calling for

• robust availability of vaccines, testing, treatment (including accelerated development and review of products to target new variants) and public health guidance;
• at least 60 days’ notice before the emergency use authorization designation expires;
• continued efforts to combat vaccine hesitancy and promote public trust in all recommended vaccines;
• continued prioritization of primary care practices in vaccine distribution;
• at least 60 days’ notice before transitioning to normal medical supply purchasing and distribution operations;
• a detailed plan for federal coordination with medical distributors to prevent disruption to the availability of COVID-19 vaccines and therapeutics; and
• clarification that the PREP Act will no longer be in effect after the end of the PHE, and a list of eligible vaccinators.

Additionally, the letter expressed concern that CDC data reporting requirements may slow or cease when the PHE ends. The Academy asked HHS “to work with the CDC and other agencies to expand reporting requirements so that the CDC can continue to monitor the pandemic after the end of the PHE” and to “transparently share how the end of the PHE may impact CDC’s surveillance efforts.”

HHS also should “ensure childhood COVID-19 vaccines and boosters are transferred seamlessly into the Vaccines for Children program once the federal government stops purchasing and distributing them,” the letter added. Noting that this program is essential for ensuring affordable access to ACIP-recommended vaccines for uninsured children and those covered under Medicaid and CHIP, the Academy advised that “transitioning childhood COVID-19 vaccines to the VFC program quickly and without disruption will help family physicians continue offering COVID-19 vaccines to children at no cost.”

Reiterating recent advocacy, the Academy said HHS should “require coverage of separate vaccine counseling for all ACIP-recommended vaccines across all programs and for all beneficiaries, including when counseling is provided via audio-only or audio/video telehealth.”

Medicare

The Academy outlined several recommendations specific to Medicare, with particular emphasis on ensuring the continued provision of COVID-19 vaccines and boosters to Medicare beneficiaries in the primary care setting as Medicare shifts to paying practices to purchase those doses. Such an allowance, the letter said, must cover practices’ cost of acquiring and maintaining those vaccines and factor in associated overhead costs.

“Due to ongoing uncertainty regarding when the federal government will stop purchasing vaccines, in addition to whether updated vaccines or additional boosters will be required to combat new variants, it is unclear what the price of COVID-19 vaccinations will be when physician practices begin purchasing them,” the letter said. “The previously set payment allowance equal to 95% of the average wholesale price may or may not be adequate. We urge HHS to modify the payment amount as needed.”

The Academy further urged HHS to

• notify beneficiaries, clinicians and other stakeholders that Medicare will continue coverage of COVID-19 vaccines and boosters under Medicare Part B past the end of the PHE, without cost-sharing;
• permanently cover and pay for vaccine counseling when it is provided separate from vaccine administration, including when counseling is provided via audio-only or audio/video telehealth;
• continue paying for COVID-19 vaccine administration using Medicare allowances established during the PHE until the relative value of the COVID-19 and other vaccine administration codes can be thoroughly reviewed and revalued;
• provide physicians, beneficiaries and other stakeholders with at least 60 days’ notice before transitioning the purchase of COVID-19 vaccine supplies to physician practices;
• no later than 60 days before the end of the PHE, publish guidance to Medicare administrative contractors and Medicare Advantage plans outlining when COVID-19 therapeutics and diagnostic services must be covered;
• direct Medicare Advantage plans to follow the same policies recommended for traditional Medicare; and
• prohibit the use of prior authorization and other utilization management techniques to determine coverage and payment for COVID-19 related services.

Medicaid

To prevent barriers to lifesaving services (such as COVID-19 vaccines and treatments) that could lead to worse health disparities, the Academy counseled HHS to

• ensure that states continue to provide coverage and payment for COVID vaccines, testing and therapeutics for one year after the PHE without cost-sharing;
• require Medicaid and CHIP coverage and payment for separate vaccine counseling for all Medicaid beneficiaries;
• encourage states to cover vaccine counseling when provided via audio-only and audio/video telehealth;
• encourage states to cover COVID-19 vaccines, therapeutics and diagnostic services without cost-sharing for all beneficiaries once federal coverage requirements expire;
• ensure states set adequate payment rates for COVID-19 related services; and
• consider implementing network adequacy and other minimum access standards for COVID-19 related care in future rulemaking.

Private Payers

Patients enrolled in private health plans, the Academy said, should be assured “robust coverage of COVID-19 vaccines, tests and therapeutics without cost-sharing after the end of the PHE.” Any federal post-PHE plan also should prohibit the use of prior authorization or other utilization management requirements to determine coverage for COVID-19 related care after the emergency, the letter added, with enrollees notified at least 30 days before the end of the PHE about any changes to their coverage.

Continuous Coverage for All

The Academy expressed concern that millions of Medicaid beneficiaries may lose coverage, along with vital care continuity, when states redetermine eligibility after the PHE.

“We have repeatedly recommended HHS provide states and Medicaid managed care plans with at least 120 days’ notice before unwinding federal enrollment and maintenance of effort requirements,” the letter said, prefacing a number of specific policy recommendations focused on enrollee outreach and federal assistance to state programs. “We believe this advanced notice will assist states in deciding when to increase their workforce, ramp up enrollee outreach efforts, update their IT systems and implement administrative processes needed to conduct redeterminations and minimize coverage disruptions.”

To allow eligible Medicaid beneficiaries to enroll in Medicare once federal continuous enrollment requirements end, the letter added, HHS should swiftly finalize a recently proposed rule streamlining Medicare eligibility and enrollment.

Telehealth

Noting that Congress extended PHE telehealth flexibilities for 151 days after the emergency, the letter repeated the Academy’s longstanding call for telehealth coverage and payment policies ensuring timely, equitable access to telehealth services from patients’ usual source of care. The AAFP’s guidance in this area included a call to cement coverage of, and proper payment for, audio-only telehealth services across programs and permanently allow federally qualified health centers and rural health centers to provide telehealth services.

Noting that PHE telehealth flexibilities have been vital for patients needing access to medication-assisted treatment for opioid use disorder, the AAFP called on HHS (along with the Department of Justice) to make permanent such flexibilities. Accompanying policies, the letter added, should be enacted to facilitate access to OUD treatment.