What Providers Need to Know as They Face the End of Pandemic Emergency Rules

The Public Health Emergency (PHE) for the COVID-19 pandemic, issued by the U.S. Department of Health and Human Services (HHS) in January of 2020 begins expiring in May 2023.

The expiration of rules will have repercussions across healthcare, but three areas may have more changes than others: telehealth, nurse training and hospital-at-home arrangements.

End of pandemic emergency rules and telehealth

At the pandemic’s peak, telehealth accounted for 40% of behavioral health services and 13% of all outpatient visits, largely due to federally granted exceptions to telehealth regulations. Those exceptions will be phased out.

Telehealth still accounts for 36% of behavioral health services even as other telehealth services have dropped to 5%.¹ Congress has extended telehealth exceptions for Medicare and Medicaid patients, but those will expire in December 2024.

In addition, the HHS has started enforcing HIPAA rules requiring “reasonable safeguards” for patient privacy, resulting in penalties for using non-compliant technology. HIPAA-compliant technology is available for smartphones, but many third-party apps rolled out during the pandemic do not qualify.

Training requirements will be reinstated

The PHE suspended the national requirement for 75 hours of state-approved training for nursing professionals, but the training rules will go back into effect, although individual states and facilities can request to be held to lower standards. As of March, 17 states and over 350 nursing home facilities have done so.²

It can be a daunting issue, particularly in senior care, as the suspension of training rules helped nursing homes stay staffed and running during the pandemic. Those hired during the suspension must be trained by September 10, 2023 to remain employed.

In addition, waivers for offering “hospital-at-home” services will end in December 2024, which had 114 health systems and 253 hospitals approved to offer these services.³ The concept has reduced costs as much as 38%⁴ and improved patient outcomes.

Risk assessments in order

Providers need to look at the end of the PHE and evaluate how much risk comes with each change. Not only did the pandemic alter how some providers offered services, but it changed which services they offered.

Providers with telehealth services will need to assess if the additional risk will be worth the ability to see more patients. Those with large nursing staffs have to decide whether to pay for more training to keep their roster fully staffed. Providers offering hospital-at-home services will have to evaluate whether that means adding beds and staffing, or reevaluating the services they offer.

Evaluating risk in these processes and services will be critical to maintaining patient safety and mitigating the risk of malpractice claims (particularly in offering telehealth services, which could be open to misdiagnosis and misappropriation of patient data).

HUB International’s healthcare experts are ready to help your organization respond to the opportunities and risks in a constantly changing healthcare environment.

¹ KFF, “Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic,” March 15, 2022.
² CBS News, “From addiction treatment to nursing homes, end of COVID emergency will bring changes across U.S. health care system,” March 21, 2023.
³ American Hospital Association, “Fact Sheet: Extending the Acute Hospital Care at Home Program Beyond the End of the COVID-19 PHE,” accessed April 17, 2023.
⁴ Chicago Tribune, “Hospitalization at home? Some Illinois hospitals are giving it a try,” June 7, 2022.