President Biden Announces End to Public Health and National Emergencies
On January 30, 2023, the Biden Administration announced it intends to end the COVID-19 national emergency and public health emergency declarations effective May 11, 2023. The end of these emergency declarations will impact employer-sponsored group health plans in a number of ways and employers should be familiar with and begin planning for these changes.
Background
When the COVID-19 pandemic began in early 2020, the Trump Administration declared a Public Health Emergency (PHE) and later declared a National Emergency. These emergencies provided flexibility to the federal and state governments to expedite and expand access to critical treatment, vaccines, and healthcare coverage during the pandemic. Many of the provisions were primarily focused on individuals covered by Medicare and Medicaid, but some affected group health plans.
The Biden Administration’s most recent announcement will result in the expiration of both the National Emergency and the Public Health Emergency, effective May 11, 2023.
What Does This Mean For Group Health Plans?
Public Health Emergency
Under the PHE, group health plans are obligated to cover COVID-19 tests (including certain over-the- counter tests) and testing-related services without cost sharing or prior authorization. Plans are required to reimburse out-of-network providers for tests and related services, even if the plan provides coverage for other covered services in-network only. Additionally, group health plans and insurers must cover COVID-19 vaccines without cost sharing for in-network and out-of-network providers.
Once the PHE expires, expanded coverage for COVID-19 testing will no longer be mandated. Post-PHE, a plan may continue to cover COVID-19 testing at no cost or begin to impose cost-sharing. The expiration of the PHE will also end the requirement for COVID-19 vaccines to be covered without cost-sharing.
Post-PHE, a plan may continue to cover the vaccines at no cost or begin to impose cost-sharing. To the extent a plan wishes to change its coverage of these items, the effective date of those changes should be determined in consultation with the plan’s carrier or TPA.
The PHE declaration allowed an employer to offer stand-alone telehealth benefits to employees who are not eligible for the employer’s major medical coverage. To the extent such coverage was offered, it will remain in place for the full duration of any plan year that begins on or before the last day of the PHE, after which time the stand-alone telehealth coverage will end.
National Emergency
The end of the National Emergency will have other impacts to group health plans. Under emergency regulations issued in 2020, plans have been required to toll (in other words, stop the clock on) a number of administrative deadlines during to COVID-19 Outbreak Period. Deadlines for electing COBRA, paying COBRA premiums, electing HIPAA special enrollment, and filing claims and appeals have been tolled until the earlier of one year from the original deadline, or 60 days from the end of the National Emergency. If the emergencies end as announced on the May 11, 2023 effective date, plan sponsors should begin administering their plans according to the normal statutory deadlines no later than July 10, 2023. With respect to the tolling of COBRA deadlines, plan sponsors should be sure to revise their general and election notices to remove any language pertaining to tolled deadlines.
Some plans may have delayed sending certain required notices to participants while the tolling relief was in place. Where the provision of such plan-related notices has been delayed, they should be prepared and sent as soon as administratively practicable after the end of the National Emergency.
Plan Sponsor Next Steps
As the emergency declarations wind down, plan sponsors should work with their insurance carriers or third-party administrators to determine how their plan will cover COVID-19 tests and related services after the end of the PHE. Plan documents will likely need to be amended and the coverage changes will need to be communicated to plan participants.
The end of the National Emergency and its impact on plan participants will need to be communicated, particularly to individuals who are under a tolled deadline, but also to the broader participant population. Plan sponsors should check with their COBRA administrator to confirm they have a plan for updating notices, identifying, and communicating with affected individuals to ensure they are aware of the new deadlines. Employers who self-administer COBRA will need to revise their General Notice and Election Notice to remove language regarding tolled deadlines, identify individuals who will be affected by this change, notify them of their new deadlines, and administer notices, elections, and payments properly during the transition period.
It is important to note that the announcement was a notification of the Biden Administration’s intent to declare an end to the COVID-19 emergencies effective May 11, 2023, but they have not yet issued an official declaration ending these emergencies. It is possible that this date could change so plan sponsors and benefit administrators should continue to monitor developments and adjust their schedules accordingly.
Questions?
Please contact your Benefit Advisor with any questions about the end of these emergencies and their impact on your health plan.
Disclaimer: The information provided in this bulletin does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available through this bulletin are for general informational