HHS releases additional guidance ahead of COVID-19 PHE conclusion

Wednesday, April 5, 2023

HHS and other government agencies recently published an FAQ on the implementation of the Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief, and Economic Security (CARES) Act, and HIPAA. The FAQ detailed how the COVID-19 public health emergency (PHE) conclusion, which is expected to occur on May 11, will impact coverage of testing, treatment, and preventive services.

COVID-19 testing coverage requirements under section 6001 of the FFCRA will not apply after the PHE conclusion, according to the FAQ. HHS said plans and issuers will not be required to cover diagnostic tests and associated items or services furnished after the PHE conclusion.

HHS said it encourages plans and issuers to continue providing this coverage, without imposing cost sharing or medical management requirements, when the PHE ends. The department also encouraged them to “notify participants, beneficiaries, and enrollees of key information regarding coverage of COVID-19 diagnosis and treatment, including testing.”

Reimbursement and cash price posting requirements under section 3202 of the CARES Act will not apply to COVID-19 diagnostic tests furnished after the end of the PHE, according to the FAQ.

However, HHS clarified that the CARES Act statutory requirements related to rapid coverage of preventive services for COVID-19 will apply to qualifying services furnished after the end of the PHE. Under the act, plans and issuers are required to provide coverage after the PHE conclusion for COVID-19 vaccines and their administration.

CMS also released guidance on the PHE conclusion, clarifying the reporting of modifier -CR (catastrophe/disaster related) and condition code DR (disaster related). The modifier and condition code are only to be reported when a formal waiver is in place during a PHE, so providers should “plan to discontinue using them for claims with dates of service on or after May 12,” said CMS.

For benefit period and qualifying stay waivers, skilled nursing facilities and swing bed providers should submit condition code DR for inpatient claims with admission dates before May 12, said CMS. Providers

With the PHE conclusion approximately one month away, revenue integrity professionals must ensure their organization is in compliance throughout the transition. Review the FAQ and understand how coverage of COVID-19 testing, treatment, and preventive services will change when the PHE ends. can find more information in the Medicare Claims Processing Manual. Ensure claims with dates of service on or after May 12 do not include disaster-related modifiers or condition codes.

Editor’s note: Find more NAHRI resources on COVID-19 here.