Family physicians want federal plan to transition out of COVID-19 public health emergency

Federal regulators should consider policies to avoid “considerable disruptions” in the U.S. health care system, before the end of the public health emergency (PHE) declared for the COVID-19 pandemic, according to the American Academy of Family Physicians (AAFP).

This month, AAFP published its recommendations for ending the COVID-19 public health emergency, in a letter to U.S. Department of Health and Human Services Secretary Xavier Becerra.

AAFP appreciates the emergency waivers, flexibilities, coverage policies, and other actions that helped family physicians and other frontline clinicians to care for patients and keep their practices open, academy Board Chair Ada D Stewart, MD, FAAFP, said in the letter.

“Given that many of these policy changes have been in place for two years and, in some cases, have significantly altered the health care coverage and delivery landscape, transitioning away from the federal PHE could cause considerable disruptions to physicians and their patients,” Stewart said in the letter. “To prevent disruption across the health care system, it is vital that HHS implements a transparent, intentional, and equity-focused approach to ending the PHE and unwinding its associated policy changes.”

Timely concerns

The AAFP letter came out before the current PHE deadline of July 16. HHS had a deadline of May 16 to notify the public that the PHE would end in 60 days. But that deadline came and went with no formal announcement, so the PHE is expected to last beyond July 16, but how long is unknown.

AAFP suggested the PHE continue at least through the end of 2022, and publish a plan outlining what will change when it ends. That plan should have a public comment period of at least 60 days and should work with other federal departments, such as Treasury and Labor, to minimize disruptions and address gaps in health care coverage and access.

Policies to examine

The 17-page letter has a number of recommendations on multiple issues including the roles of various federal agencies, vaccine availability, and rules affecting Medicare, Medicaid, and private insurance. Among the suggestions:

• Continue prioritizing primary care practices in vaccine distribution.
• Maintain federal Centers for Disease Control (CDC) reporting requirements that inform physicians’ counsel to patients.
• Transfer childhood COVID-19 vaccines and boosters to the CDC’s Vaccines for Children program so family physicians can offer the shots at no cost.
• Prohibit the use of prior authorization requirements for COVID-19 vaccines, tests, and treatments.
• Permanently cover and pay for vaccine counseling when it is provided separately from vaccine administration, including audio-only and audio/video telehealth, for Medicare beneficiaries.
• Ensure states continue providing coverage and payment for COVID-19 vaccines for a year beyond expiration of the PHE, without cost-sharing, for Medicaid recipients.
• Provide at least 120 days’ notice before ending the provisions that allowed states to enroll more people in Medicaid during the pandemic. When those end, states must conduct Medicaid eligibility redeterminations a process that “will cause significant disruptions in access to health care” and end coverage for millions of people.

Telehealth

The AAFP recommendations strongly support telehealth flexibilities that will last at least 151 days after the end of the PHE. Going forward, the federal regulators should:

• Make it easier to use telehealth services provided by patients’ usual sources of care.
• Refrain from directing or incentivizing patients to use direct-to-consumer telehealth services.
• Include coverage of and proper payment for audio-only telehealth services.
• Enable federally qualified health centers and rural health centers to use telehealth services for millions of low-income patients.
• Work with the federal Drug Enforcement Agency to allow physicians to prescribe drugs for opioid use disorder via telehealth visits.