End of national Covid emergency brings changes to pandemic care and data in Vermont

By ERIN PETENKO

VTDigger

Published: 05-13-2023 7:58 PM

The federal government plans to end the national public health emergency for COVID on May 11, after more than three years of wide-ranging, pandemic-induced changes to the health care system — in Vermont and throughout the country.

The public health emergency, first put in place in January 2020, set requirements for COVID-related health care, loosened restrictions on telehealth and hospital practices, and made it easier for the federal government to collect COVID data and track COVID supplies.

Its end is not expected to change every one of those rules, thanks to efforts to extend pandemic-era initiatives through other routes. But some experts have expressed concern about the erosion of COVID mitigation practices and the loss of COVID care coverage, particularly for low-income Vermonters.

Here’s what’s expected to change in Vermont and what is likely to remain in place, at least for now.

Coverage for COVID care

The national emergency set rules governing what insurers needed to cover for COVID care, including PCR tests ordered by doctors’ offices or hospitals, and antigen tests picked up at a doctor’s office or over the counter at a pharmacy.

Starting July 1, BlueCross BlueShield of Vermont will no longer cover over-the-counter antigen tests, according to Sara Teachout, a spokesperson for the state’s largest private insurance company.

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COVID vaccines and tests given out by a primary care provider would be covered without a copay, since it falls under preventive care covered by its insurance plans, according to Teachout. But COVID medications and treatments at a hospital could cost patients money, depending on the copay, deductible and coinsurance coverage under their plan.

“As COVID-19 becomes endemic, all testing, vaccinations and treatment of COVID-19 will be covered by insurance like all other common health conditions,” Teachout wrote in an email.

Vermont’s other private insurer, MVP, said its customers “may soon see changes to COVID-19 related coverage.”

“Reversal of the many COVID-19 (public health emergency) rules is complicated, and MVP is working to fully assess and communicate changes to our customers and provider partners through an ongoing, but expedited process,” wrote Michelle Golden, a spokesperson for MVP.

She did not respond to follow-up questions about specific COVID care coverage such as over-the-counter antigen tests. Medicare will also end coverage for over-the-counter COVID tests, according to the U.S. Department of Health and Human Services.

Medicaid coverage, on the other hand, has received an extension. Vermont plans to extend most COVID coverage measures without cost-sharing through Sept. 30, 2024, according to Andrea DeLaBruere, commissioner of the Department of Vermont Health Access, which administers the program.

“I’m hopeful that we can continue to offer the services to Vermonters that they deserve and need,” she said. “And COVID treatment is part of that.”

Access to vaccines and antiviral medications such as Paxlovid, regardless of insurance status, are also expected to remain in place, at least for now. The federal government will still provide both while it works to transition COVID vaccines and treatment to a more traditional health care system, according to the Department of Health and Human Services.

Mark Levine, commissioner of the Vermont Department of Health, said the federal government still had “a lot of” COVID vaccines to provide to uninsured people.

Similarly with Paxlovid, he said, “they’ll continue to give it to everybody for free while they still have the supply and while, of course, it still works.”

Hospitals, health care providers and telehealth

One Vermont organization with concerns about the end of the national public health emergency is its largest health care provider, the University of Vermont Health Network.

The network — which includes three Vermont hospitals, a hospice center and doctors’ offices throughout the state — will be affected by the end of Medicare and Medicaid waivers that allowed them greater flexibility in managing their operations, according to network spokesperson Annie Mackin.

The flexibilities that are ending include screening patients for COVID off-site, using surge sites during staffing shortages and long-term care outbreaks, creating “swing beds” to manage patients, expanding certain hospitals’ capacity, and waiving a rule that requires a three-day hospital stay before patients can be admitted to long-term care facilities.

Mackin said that the network was advocating for some “key provisions” to remain in place beyond the end of the national emergency, with a focus on the ability of physicians to virtually supervise radiology assistants.

Some waivers related to telehealth care should remain in place after the end of the emergency, according to the Department of Health and Human Services. Congress has passed legislation to protect Medicare coverage of telehealth through December 2024, while Vermont had Medicaid provisions for telehealth prior to the pandemic.

The UVM Health Network was advocating for some telehealth rules to be expanded even past 2024 — such as providing occupational therapy and mental health treatment by telehealth, which were not allowed prior to the pandemic, Mackin said.

DeLaBruere, of the Department of Vermont Health Access, said the state also would keep a pandemic-era provision to allow Medicaid patients to get “audio-only” health services, such as over the phone, rather than only being able to do “audiovisual” visits such as Zoom calls.

“It has been a good addition to allow patients to have flexibility, especially for those living in more rural areas where broadband is an issue,” she said. The state is planning to cover it through December 2024 while it evaluates how people are using phone-based services.

Still up in the air is one telehealth provision that allows people to get access to controlled medications via telehealth services. The U.S. Drug Enforcement Administration is considering whether to loosen its restriction on that practice beyond the end of the national emergency.

National data reporting and federal vaccine rules

The U.S. Centers for Disease Control and Prevention plans to change the way it displays COVID data as the national emergency ends data reporting requirements, according to CNN.

The federal agency’s community levels — represented in green, yellow and red each week depending on hospitalization and case rates — will stop being tracked, CNN reported.

It’s unclear at this point what data the CDC plans to report after May 11. The CDC website says only, “CDT pages and visualizations will be updated on May 11, 2023, based on available data after the expiration of the federal COVID-19 public health emergency.”

According to the U.S. Department of Health and Human Services, the end of the national emergency will end requirements for COVID testing laboratories and immunization data systems to report data to the CDC. Hospitals are still required to share their data through April 2024.

Vermont plans to continue reporting its own COVID community levels for the foreseeable future, since state laws require labs to provide the state COVID test results, according to health department spokesperson Katie Warchut.

But the CDC has county-level data that Vermont does not provide, along with national data that provides context for Vermont’s COVID numbers.

President Joe Biden announced another change to vaccination requirements on May 1, relaxing vaccination requirements for federal workers and international travelers coming into the United States.

That means, for the first time in years, Canadians who are not fully vaccinated can cross the land border to Vermont. International flyers can also come into the country without having to show proof of vaccination.

The administration’s press release cited the national drop in COVID deaths as part of the justification for the change.

“We are in a different phase of our response to COVID-19 than we were when many of these requirements were put into place,” the administration said in the press release.

Vermont has also reported “low” COVID levels in recent months, along with falling metrics for cases, hospitalizations and wastewater surveillance, according to the health department. But hospitalizations and deaths from the disease still happen. Sixteen people died of COVID in April, for a total of 962 deaths since the beginning of the pandemic.

Levine, the state health commissioner, said he was hopeful that Vermont and the rest of the nation would have their first truly low-COVID summers this year. The health department is planning a break from COVID messaging in anticipation of ramping up again for a vaccine campaign this fall.

He said the department has long kept an eye out for signs that a new variant or shift in the disease could require it to increase its efforts or bring back mass vaccination campaigns. But for now, “there’s nothing on the horizon that should be alarming,” he said.

“It’s no longer the thing that’s occupying every moment of every day,” he said. “We’re paying attention to the broad public health profile — not all being distracted with an all-hands-on-deck epidemic. So that’s good.”

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