A Public Health Emergency (PHE) declaration is a formal government acknowledgment of a severe health crisis that necessitates a fundamental shift in standard medical operations and regulatory oversight. This legal and administrative determination triggers a cascade of flexibilities and funding mechanisms. The PHE declaration fundamentally alters how medical services are delivered, paid for, and regulated, allowing healthcare systems to quickly adapt and mobilize resources. It signals a temporary suspension of normal rules to prioritize rapid patient care and public safety during an extraordinary period of stress on the healthcare infrastructure.
Defining a Public Health Emergency
The authority to declare a PHE in the United States rests with the Secretary of the Department of Health and Human Services (HHS). This declaration is made under Section 319 of the Public Health Service (PHS) Act, which provides the legal basis for the federal government’s response to an urgent health threat. The Secretary must determine that a disease or disorder presents a public health emergency, such as a significant infectious disease outbreak or a bioterrorist attack.
This declaration is distinct from a Presidential declaration of a national emergency or a major disaster under the Stafford Act, though they can be made concurrently. The PHE declaration focuses specifically on health-related responses, granting the HHS Secretary discretionary powers. These powers include the ability to make grants, enter into contracts, and support investigations into the cause and prevention of the disease or disorder.
A PHE declaration does not require a formal request from a state governor or tribal executive, underscoring its federal nature and the need for a unified national response. While there is no explicit statutory threshold defining the severity required, the determination allows the federal government to use specific, temporary authorities. These authorities provide the government and healthcare providers with agility not permitted under normal operating conditions to manage a large-scale health crisis.
Immediate Changes Triggered by a PHE
The declaration of a PHE immediately unlocks regulatory flexibilities and financial adjustments, primarily through Section 1135 waivers under the Social Security Act. These waivers allow the HHS Secretary to temporarily modify or suspend certain requirements within Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This regulatory relief is often tied to both a PHE declaration and a separate Presidential declaration of an emergency or disaster.
Expansion of Telehealth Services
A primary change is the expansion of telehealth services. During a PHE, restrictions are waived regarding the geographic location of the patient and the originating site for the service, allowing patients to receive telehealth in their homes, regardless of their location. Medicare can be authorized to reimburse telehealth services at the same rate as in-person visits, a financial parity intended to encourage the use of remote care to protect both patients and providers. Furthermore, the list of authorized providers who can furnish distant-site telehealth services is often temporarily expanded.
Facility and Personnel Flexibility
Regulatory flexibility also extends to facility and personnel requirements. PHE waivers can suspend requirements for certain facility types and licensing rules, such as allowing for the temporary waiver of state-specific licensure for providers licensed in another state. For hospitals, the declaration can suspend rules like the requirement for a three-day prior hospitalization before a Medicare patient is eligible for skilled nursing facility care. These waivers are designed to maximize the capacity of the healthcare system and the available workforce to handle a sudden surge in patient volume.
Financial Support Mechanisms
Financial mechanisms are swiftly altered to provide immediate funding and support. For example, during a PHE, there may be temporary increases in the Federal Medical Assistance Percentage (FMAP), which is the federal government’s share of Medicaid costs. Additionally, rules for remote patient monitoring (RPM) are relaxed to allow for reimbursement for services provided to both new and established patients, which is usually restricted to established patients outside of an emergency. These financial and regulatory shifts provide a lifeline to providers facing increased operational costs and the rapid need for new service delivery models.
The Process of Ending Emergency Status
A PHE declaration is inherently temporary, lasting for the duration of the emergency or for 90 days, whichever is shorter. If the crisis persists, the Secretary must officially renew the declaration for an additional 90-day period. The PHE status can be terminated earlier if the Secretary determines the emergency no longer exists.
The termination of a PHE triggers a complex transition period for temporary waivers and funding streams. Many regulatory flexibilities do not expire immediately; instead, they are phased out over time to allow healthcare providers and patients to adjust. For example, some telehealth flexibilities may be extended through the end of the calendar year, while others revert immediately to pre-PHE rules.
Resumption of Eligibility Processes
A significant part of the transition involves the resumption of standard eligibility processes for federal programs. During a PHE, states may be required to maintain continuous enrollment for Medicaid beneficiaries. Once the PHE ends, states must begin redetermining eligibility for millions of beneficiaries, a process that can take 12 months or longer to complete. This transition requires careful planning to ensure eligible individuals do not lose coverage and that healthcare operations return to normal regulatory standards without immediate disruption.