New Challenge for Docs: End of COVID Federal Public Health Emergency

Kerry Dooley Young

February 14, 2023

Physicians nationwide will be challenged by the "unwinding" of the federal public health emergency declared for the COVID-19 pandemic.

The Biden administration intends to end by May 11 certain COVID-19 emergency measures used to aid in the response to the pandemic, while many others will remain in place.

A separate declaration covers the US Food and Drug Administration's emergency use authorizations (EUAs) for COVID medicines and tests. That would not be affected by the May 11 deadline, the FDA said. In addition, Congress and state lawmakers have extended some COVID response measures.

The result is a patchwork of emergency COVID-19 measures with different end dates.

The American Medical Association and the American Academy of Family Physicians (AAFP) are assessing how best to advise their members about the end of the public health emergency.

Several waivers regarding copays and coverage and policies regarding controlled substances will expire, Claire Ernst, director of government affairs at the Medical Group Management Association, told Medscape.

The impact of the unwinding "will vary based on some factors, such as what state the practice resides in," Ernst said. "Fortunately, Congress provided some predictability for practices by extending many of the telehealth waivers through the end of 2024."

AAFP told Medscape that it has joined several other groups in calling for the release of proposed Drug Enforcement Administration (DEA) regulations meant to permanently allow prescriptions of buprenorphine treatment for opioid use disorder via telehealth. AAFP and other groups want to review these proposals and, if needed, urge DEA to modify or finalize before there are any disruptions in access to medications for opioid use disorder.

Patients' Questions

Clinicians can expect to field patients' questions about their insurance coverage and what they need to pay, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association (AHA).

"Your doctor's office, that clinic you typically get care at, that is the face of medicine to you," Foster told Medscape. "Many doctors and their staff will be asked, 'What's happening with Medicaid?' 'What about my Medicare coverage?' 'Can I still access care in the same way that I did before?'"

Physicians will need to be ready to answers those question, or point patients to where they can get answers, Foster said.

For example, Medicaid will no longer cover postpartum care for some enrollees after giving birth, said Taylor Platt, health policy manager for the American College of Obstetricians and Gynecologists.

The federal response to the pandemic created "a de facto postpartum coverage extension for Medicaid enrollees," which will be lost in some states, Platt told Medscape in an email. However, 28 states and the District of Columbia have taken separate measures to extend postpartum coverage to 1 year.

"This coverage has been critical for postpartum individuals to address health needs like substance use and mental health treatment and chronic conditions," Platt said.

States significantly changed Medicaid policy to expand access to care during the pandemic.

All 50 states and the District of Columbia, for example, expanded coverage or access to telehealth services in Medicaid during the pandemic, according to a January 31 report from the Kaiser Family Foundation (KFF). These expansions expire under various deadlines, although most states have made or are planning to make some Medicaid telehealth flexibilities permanent, KFF said.

The KFF report notes that all states and Washington, DC, temporarily waived some aspects of state licensure requirements, so that clinicians with equivalent licenses in other states could practice via telehealth.

In some states, these waivers are still active and are tied to the end of the federal emergency declaration. In others, they expired, with some states allowing for long-term or permanent interstate telemedicine, KFF said. (The Federation of State Medical Boards has a detailed summary of these modifications.)

The End of Free COVID Vaccines, Testing for Some Patients

AAFP has also raised concerns about continued access to COVID-19 vaccines, particularly for uninsured adults. Ashish Jha, MD, MPH, the White House COVID-19 Response Coordinator, said in a tweet last week that this transition, however, wouldn't happen until a few months after the public health emergency ends.

After those few months, there will be a transition from US government-distributed vaccines and treatments to ones purchased through the regular healthcare system, the "way we do for every other vaccine and treatment," Jha added.

But that raises the same kind of difficult questions that permeate US health care, with a potential to keep COVID active, said Patricia Jackson, RN, who is president of the Association for Professionals in Infection Control and Epidemiology (APIC).

People who don't have insurance may lose access to COVID testing and vaccines.

"Will that lead to increases in transmission? Who knows," Jackson told Medscape. "We will have to see. There are some health equity issues that potentially arise."

Future FDA Actions

Biden's May 11 deadline applies to emergency provisions made under what's called a Section 319 declaration, which allow the Department of Health and Human Services to respond to crises.

But a separate flexibility, known as a Section 564 declaration, covers the FDA's EUAs, which can remain in effect even as the other declarations end.

The best-known EUAs for the pandemic were used to bring COVID vaccines and treatments to market. Many of these have since been converted to normal approvals as companies presented more evidence to support the initial emergency approvals. In other cases, EUAs have been withdrawn owing to disappointing research results, changing virus strains, and evolving medical treatments.

The FDA also used many EUAs to cover new uses of ventilators and other hospital equipment and expand these supplies in response to the pandemic, said Mark Howell, AHA's director of policy and patient safety.

The FDA should examine the EUAs issued during the pandemic to see what greater flexibilities might be used to deal with future serious shortages of critical supplies. International incidents such as the war in Ukraine show how fragile the supply chain can be. The FDA should consider its recent experience with EUAs to address this, Howell said.

"What do we do coming out of the pandemic? And how do we think about being more proactive in this space to ensure that our supply doesn't bottleneck, that we continue to make sure that providers have access to supply that's not only safe and effective, but that they can use?" Howell told Medscape.

Such planning might also help prepare the country for the next pandemic, which is a near certainty, APIC's Jackson said. The nation needs a nimbler response to the next major outbreak of an infectious disease, she said.

"There is going to be a next time," Jackson said. "We are going to have another pandemic."

Kerry Dooley Young is a freelance journalist based in Miami.

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