End of the PHE: Summary of Federal Resources for the Transition

To assist you with the transition away from the COVID-19 public health emergency (PHE), SHEA has distilled many of the most important pieces of information into a high-level of summary of what you will need to know. The information organized in the table below was taken from a number of federal guidance documents, memos, and web sites that discuss what is and is not changing after May 11. Although this information is comprehensive, readers are encouraged to also review original sources provided on this resource page.

Testing/Treatment/Vaccines

What is not changing/being extended

What is changing/ended May 11

Continuation of COVID-19 Emergency Use Authorization Declaration

Vaccine requirements for healthcare personnel, federal employees, federal contractors and international travelers end; ability to get free COVID tests ends
V-safe check in will end June 30. Patients can still report side effects to VAERS directly.

Reporting/Quality Measures

What is not changing/being extended

What is changing/ended May 11

COVID-19 hospital reporting
COVID-19 LTC reporting requirements

Beginning June 11, hospitals will have the option to report a reduced number of data elements
Hospital reporting cadence will go from daily to weekly
Quality Assessment and Performance Improvement Programs must be back in place

IPC Guidance

What is not changing/being extended

What is changing/ended May 11

Source control is still recommended for:
- Persons with suspected/confirmed COVID-19 or other respiratory infection;
- Persons with close contact (pts and visitors) or higher-risk exposure (HCP) for 10 days;
- Unit or area experiencing a COVID-19 or other respiratory infection outbreak;
- Facility-wide or targeted to high-risk areas or patient populations during periods of higher community COVID-19 or other respiratory virus transmission;
- When recommended by local public health;
No changes in recommendations around recommended infection prevention and control practices when caring for patients with suspected or confirmed COVID-19 at this time.
No changes in recommendations to optimize engineering controls and indoor air quality.

CDC will no longer be receiving data that is needed to publish COVID-19 Community Transmission Levels or Community Levels but will continue to provide weekly COVID-19 hospital admission levels to guide actions.
The updated CDC IPC Guidance includes an expanded discussion around considerations for implementing broader use of masking in healthcare settings.
Comprehensive COVID-19 vaccination data will only be accessible in states and territories with CDC data use agreements.
Testing on admission is no longer required for nursing homes and may be done at the discretion of the facility.

Long-Term Care Settings

What is not changing/being extended

What is changing/ended May 11

LTCs must inform residents, families, and representatives of COVID-19 cases; enforcement discretion remains in place.
LTCs must provide education about offering residents and staff the COVID-19 vaccine.

SNFs must return to compliance requirements for pre-pandemic pre-admissions screening
SNFs must return to compliance with requirements for providing alcohol-based hand-rub dispensers
Pre-pandemic SNF requirements for resident roommates and grouping are back in place
SNFs are no longer required to provide routine testing of LTC staff and residents for COVID-19 infection (guidance for when to test residents and staff based on CDC recommendations remains in place)

Providers/Waivers

What is not changing/being extended

What is changing/ended May 11

PREP Act immunity from liability extended through December 2024 for pharmacists, pharmacy interns, and pharmacy technicians to administer COVID-19 and seasonal influenza vaccines, and COVID-19 tests to those 3 and over.
Federal agreements related to COVID-19 countermeasures will be covered through December 2024, including those provided by the United States Government (USG) or conducted by Federal employees, contractors, or volunteers.
Acute care Hospital At Home Initiative remains in place.

PREP Act coverage will end for COVID-19 vaccination by non-traditional providers and across state lines by licensed providers and pharmacists and pharmacy interns once products are no longer distributed under a USG agreement.
PREP Act coverage will also end for routine childhood vaccinations by pharmacists, pharmacy interns, and pharmacy technicians once there is no longer an emergency in effect.
CMS authority to issue and maintain waivers and flexibilities under Section 1135 of the Social Security Act will end.
CMS expects inpatient and outpatient providers and suppliers to begin full-scale emergency preparedness exercises based on regulatory requirements.
ASCs are no longer allowed to temporarily enroll as hospitals to extend hospital capacity for COVID-19 patient care (additional guidance for permanent conversion to hospital status is provided).
Hospitals must screen patients for admission in accordance with the Emergency Medical Treatment & Labor Act. Screening for COVID-19 can no longer take place offsite from the hospital’s campus.
Waivers for verbal order requirements is ending.
Waivers for sterile compounding that allowed used face masks are discontinued.
Requirements for physician privileges for hospital practice are back in place.
Requirements for hospital physical environment (previously waived to accommodate surge capacity) are back in place.
Hospitals and CAHs must have emergencies preparedness policies and procedures in place.
Care in temporary expansion sites will no longer be permissible.
Hospitals may no longer relocate inpatient rehab or inpatient psychiatric patients in designated units to an acute care bed to accommodate hospital surge.
minimal personnel qualifications and staff licensure in acute care and CAHs are no longer waived.
CAH length of stay requirements are back in place.

Coverage/Payers

What is not changing/being extended

What is changing/ended May 11

Paxlovid or treatments available through federal supplies will not be charged to patients.
Existing supplies of COVID vaccine will not be charged to patients.
Timeframes to complete election or other actions are extended until 1 year from the date the participant, beneficiary, or plan was first eligible for relief or 60 days after the end of the COVID-19 National Emergency, whichever is earlier.

Beneficiaries are no longer eligible for eight free COVID tests per month through insurance coverage at point of purchase or insurer reimbursement.
All vaccines not federally published must be covered by insurance.
Traditional Medicare will no longer cover home tests.
PCR tests may be subject to cost sharing.
Medicaid beneficiaries will no longer have access to continuous enrollment; this provision ended earlier and states have started this process.
Plans and issuers are not required to cover COVID-19 diagnostic tests, including over-the-counter (OTC) COVID-19 diagnostic tests, without imposing any cost-sharing requirements, prior authorization, or other medical management requirements. EBSA encourages plans and issuers to continue to provide coverage without imposing cost sharing or medical management requirements after the PHE ends.
Waiver of requirements for the provision of hospital swing beds is ending

HIPAA

What is not changing/being extended

What is changing/ended May 11

HHS Office for Civil Rights (OCR) is ending HIPAA enforcement discretion There will be a 90-day transition period in effect between on May 12, 2023 and August 9, 2023. This includes:

COVID-19 Community-Based Testing Sites During the COVID-19 Nationwide PHE and certain covered health care providers, including some large pharmacy chains, and their business associates to participate in the operation of COVID–19 specimen collection and testing sites
Telehealth Remote Communications for COVID-19
Uses and Disclosures of Protected Health Information by Businesses Associates for Public Health and Health Oversight Activities for COVID-19
Online or Web-Based Scheduling Applications for the Scheduling of Individual Appointments for COVID-19 Vaccination

Telehealth

What is not changing/being extended	What is changing/ended May 11
Popular Medicare telehealth provisions are extended through 2024 Waivers for patient access to telehealth services DEA and HHS have drafted a proposed rule to extend telehealth flexibilities for prescribing controlled substances	Requirements for written telehealth agreements between hospitals and CAHs go back in place

Notes:

CMS says it will utilize enforcement discretion where some providers are still constrained by workforce shortages and where the discontinuation of waivers may present a burden.
The pandemic has highlighted the need for better preparedness and coordination in responding to public health emergencies. This work must continue. There will be a next pandemic and future public health crises.
We should continue to emphasize the importance of vaccination with patients and healthcare personnel. The widespread availability of COVID-19 vaccines has been a critical factor in bringing an end to the public health emergency.

Events
The following upcoming events are opportunities to learn more about the end of the PHE. Thanks to all of you who submitted questions already. Please continue to submit your questions via email. We will make every effort to address your questions though one of these platforms.

Project Firstline: Infection Prevention and Control Post-COVID-19 PHE – Recommendations for Health Care Professionals
Tuesday, May 16, 12:30pm – 1:30pm (EDT)

Description: In this town hall, hosted by CDC’s Project Firstline, CDC officials will review the updates to these recommendations and the infection control actions that continue to be effective at stopping the spread of respiratory viruses in health care. This town hall will also feature a panel of health care professionals that will discuss how they will operationalize these updated recommendations in their diverse facilities.

SHEA COVID-19 Town Hall
Sunday, May 21, 3:00pm – 4:00pm (EDT)

Description: During the Town Hall, our panelists will answer questions based on what they are doing in their facilities. Attendees can submit questions in advance as well as during the Town Hall. Questions that are not answered during the Town Hall will be compiled and addressed in future Town Halls. The Town Hall recording will be available on LearningCE and Facebook if you are unable to join live. Look out for registration information in a future member communication.

RESOURCES

CDC

CMS

Other Agencies

Other Summaries & Toolkits