Table 3Costs Due to Permanent Reimbursement Changes Implemented in the Second IFR. However, the ASD(HA) finds it impracticable to use Medicare's NTAPs for TRICARE's pediatric patients due to the lack of a significant pediatric population within Medicare. visits retroactive, to either January 1, 2020, or March 1, 2020. Travel for an approved NMA may qualify for the Prime Travel Benefit. Drugs that do not appear on this list will be priced at the lesser of billed charges or 95% of the Average Wholesale Price (AWP). The 32 CFR 199.17(l) paragraph being modified by this IFR was created as part of the IFR that established the TRICARE Select benefit (82 FR 45438) during which a comprehensive revision of 199.17 occurred. In the IFR, we temporarily permitted temporary hospitals and freestanding ASCs that registered with Medicare as hospitals to be reimbursed as acute care hospitals (85 FR 54914). While DoD acknowledges that some providers may have provided telephonic office visits prior to the effective date of the IFR, DoD lacks the statutory authority to make the implementation retroactive. As used in this paragraph, pediatric is defined as services and supplies provided to individuals under the age of 18, or who are being treated in a children's hospital or in a pediatric ward. KD}RcIUN^4uZ!_ W#$`W[:a' s&TVLv[-yX[- -H"!CfGDG,n!6p'!,EsIRpLlY5j+8&$5P- DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101. The IFR permanently added coverage of Medicare's HVBP Program. Suite 5101 We also find that NTAPs, given that they increase revenue under the DRG system, would not have an adverse impact on hospitals and providers. Register (ACFR) issues a regulation granting it official legal status. TRICARE SNF coverage requirements. NTAPs. You have a referral to a specialty care provider who is more than 100 miles (one-way) from your PCMs office. A diagnostic or monitoring procedure for the detection or measurement of human physiologic functions from a distance using a biotelemetry device to remotely monitor various vital signs of ambulatory patients. has no substantive legal effect. After TRICARE has recalibrated the DRGs, based on available data, to reflect the costs of an otherwise new medical service or technology, the medical service or technology will no longer be considered new under the criterion of this section. Fill out each required form completely and sign as required. For the NTAP provisions, TRICARE: (1) Shall apply Medicare NTAP adjustments to TRICARE covered services and supplies, except for pediatric (defined for NTAPs as pertaining to patients under the age of 18, or who are treated in a children's hospital or in a pediatric ward) services and supplies; (2) shall modify NTAP reimbursement adjustment rates for NTAPs at 100 percent of the average cost of the technology or 100 percent of the costs in excess of the Medicare Severity-Diagnosis Related Group (MS-DRG) payment for the case for pediatric beneficiaries; and (3) may create a reimbursement adjustment for TRICARE NTAPs, specific to the TRICARE beneficiary population under age 65 in the absence of a Medicare NTAP adjustment, using criteria similar to Medicare criteria for eligible new technologies outlined in 42 CFR 412.87 and the Medicare reimbursement criteria outlined in 42 CFR 412.88. DoD implemented temporary coverage of telephonic office visits effective May 12, 2020, in order to provide beneficiaries the option to obtain some medical services safely from home, reducing their exposure to COVID-19 and to minimize potential spread of the illness. 4 We are unable to estimate the number of providers impacted by the interstate and international licensing waiver, but expect it will be fairly small as a percentage of total TRICARE providers. This final rule will not have a substantial effect on State and local governments. Please consult the TRICARE Policy / Reimbursement Manualsto determine TRICARE benefits and coverage. modality through which it was delivered. Additionally, Defense Health Program dollars are better spent on testing, vaccination, and treatment for COVID-19, including a waiver of cost-shares for medically necessary COVID-19 testing, which remains in effect as a result of the CARES Act. Effective date of this final rule or termination of President's national emergency for COVID-19, whichever is earlier. 10 Rates and Reimbursement. Calendar Year 2017 premium rates are established for TRICARE Reserve Select and TRICARE Retired Reserve as specified in the attachment. This estimate assumes telephonic office visits will decrease after the pandemic, as beneficiaries become more comfortable or even prefer in-person visits. Actual reimbursement will vary by claim based on the authoritative guidance found in the TRICARE Reimbursement manual. With the approval or emergency use authorization of several vaccines by the U.S. Food and Drug Administration, the widespread availability of such vaccines throughout the United States, and the elimination of stay-at-home orders by most States and localities, this provision is no longer necessary. 10. TRICARE private sector claims data from mid-March 2020 through mid-September 2020 indicates there were a total of 80,541 telephonic office visits conducted. Regarding the request to expand the range of providers who can provide telephonic office visits, there is nothing in TRICARE regulation or policy excluding specific provider types such as physical therapists, occupational therapists, registered dieticians, or diabetes counselors (note: Diabetes counselors must be registered dieticians to be TRICARE-authorized providers) from providing their services via telehealth, including telephonic office visits, so long as they otherwise meet program requirements, including that all care be medically necessary and appropriate. informational resource until the Administrative Committee of the Federal and services, go to TRICARE Open Season: During TRICARE Open Season you can enroll in or change your TRICARE Prime or TRICARE Select plan. This rule is effective July 1, 2022, except for instruction 4 (the provision modifying temporary hospitals) which is effective on June 1, 2022. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. ( Both are finalized in this FR. Federal Register 03/03/2023, 159 7-1-21) Evaluation and Management Rates - SUD (Eff. ( The CMS memorandum eliminating future enrollments into the Hospitals Without Walls initiative, does not impact any of the changes from the initial IFR or in this final rule, as both require a provider to first be enrolled with CMS as a hospital under the initiative to register with TRICARE as a hospital and receive reimbursement as a hospital. Effective for discharges on or after Jan. 1, 2020, and implemented on March 3, 2021, TRICARE adopted the Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program for hospitals under the Inpatient Prospective Payment System (IPPS). %PDF-1.6 % Actual spending through the end of FY21 was $41.5M, consistent with and on the low end of that estimate. 199.14(a)(1)(iv)(B) to account for the changes to the NTAP provisions; there are no changes to the content of the HVBP provision. This site displays a prototype of a Web 2.0 version of the daily Chapter 35), PART 199CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS), https://www.federalregister.gov/d/2022-10545, MODS: Government Publishing Office metadata, Paragraph 199.4(g)(52)Permanent Coverage of Telephonic Office Visits, Paragraph 199.6(b)(4)(i)Expanded Coverage for Temporary Hospitals, Paragraph 199.4(b)(3)(xiv)SNF Three-Day Prior Stay Waiver. Follow all instructions. 11 This repetition of headings to form internal navigation links The IFR waived cost-shares and copayments for telehealth services for TRICARE Prime and Select beneficiaries utilizing telehealth services with an in-network, TRICARE-authorized provider during the President's declared national emergency for COVID-19. TRICARE's cost-shares and copayments are set by law and require copayments and cost-sharing for telehealth services to be the same as if the service was provided in person. The IFR allowed providers to be reimbursed for interstate practice, both in person and via telehealth, during the global pandemic so long as the provider met the requirements for practicing in that State or under Federal law. Given the availability of vaccines, the reduction of stay-at-home orders, and the cost of waiving telehealth cost-sharing, the ASD(HA) finds it appropriate to expire the waiver on the effective date of this rule or the date of expiration of the President's national emergency for COVID-19, whichever is earlier. This includes mileage, meals, tolls, parking, lodging, local transportation, and tickets for public transportation.for a qualified trip by a TRICARE Prime enrollee. 2021; Reimbursement Rate Clarification - Fairbanks, Alaska; Public Tools . 03/03/2023, 43 has no substantive legal effect. *Please note that the CHAMPUS Maximum Allowable Charges (CMAC) take precedence over state prevailing rates. Additionally, it assumes that while reimbursement for outpatient procedures in freestanding ASCs would be higher than had those procedures been reimbursed under the traditional reimbursement rates for freestanding ASCs, the number of facilities choosing to register as hospitals is likely to be small enough to have a negligible impact on the budget. For categories of TRICARE covered services and supplies for which Medicare has not established an NTAP adjustment for DRGs, the Director, DHA may designate a TRICARE NTAP adjustment through a process using criteria to identify and select such new technology services/supplies similar to that utilized by Medicare under 42 CFR 412.87. Vaccines Vaccines provided under the State Vaccine Program (SVP) are priced based on the vaccine price list for each SVP program. endstream endobj 895 0 obj <>stream This memo establishes the CY2017 Premium Rates for TRICARE Young Adult. the material on FederalRegister.gov is accurately displayed, consistent with 7 Since this provision was enacted, however, several vaccines have been approved or granted emergency use authorization by the FDA and are now widely available throughout the United States. h40_e+KKW=*P6&%Am,5d\`%5c~QH4Zam $|a-{oj: x} ~ EaU;u~uB` WQ,,@95uxzMl| DoD considered several alternatives to this rulemaking. A covered service provided via a telephone call between a beneficiary who is an established patient and a TRICARE-authorized provider. Start Printed Page 33013. 301; 10 U.S.C. These amounts are estimated through the end of September 2022, when we assume the President's national emergency and the HHS PHE will end. Is your sponsor an active or retired member of the Coast Guard? You may tape them (clear tape) on plain paper, 8 by 11 inches. that agencies use to create their documents. g. The HVBP Program is permanently adopted and is moved from 32 CFR 199.14(a)(1)(iii)(E)( We are similarly unable to estimate how many facilities will be eligible as TRICARE-authorized acute care facilities by registering with Medicare's Hospitals Without Walls initiative who would not have been otherwise eligible under TRICARE, but expect this to be a small number as well. The implementation of this provision was highly successful, with a significant number of beneficiaries shifting to the use of telehealth visits. This final rule revises this regulatory exclusion and permanently modifies 32 CFR 199.4(c)(1)(iii) Telehealth Services to add coverage for medically necessary telephonic office visits, in all geographic areas where TRICARE beneficiaries reside. HVBP Program. For complete information about, and access to, our official publications This page serves as a central repository for rates within the TRICARE/CHAMPUS DRG-Based Payment System. 6 Federal Register provide legal notice to the public and judicial notice Adding a sentence at the end of paragraph (a)(1)(iii)(E) introductory text; c. Redesignating paragraph (a)(1)(iii)(E)( 5 All rights reserved. documents in the last year, by the Coast Guard tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System TRICARE is a registered trademark of the Department of Defense (DoD), DHA. The second IFR, published in the FR on September 3, 2020 (85 FR 54914) temporarily: (1) Waived the three-day prior hospital qualifying stay requirement for skilled nursing facilities (SNFs); (2) added coverage for the treatment use of investigational drugs under expanded access authorized by the U.S. Food and Drug Administration (FDA) when indicated for the treatment of COVID-19; (3) waived certain provisions for acute care hospitals in order to permit TRICARE authorization of temporary hospital facilities and freestanding ambulatory surgical centers (ASCs) providing inpatient and outpatient services to be reimbursed; (4) revised the diagnosis related group reimbursement (DRG) at a 20 percent higher rate for COVID-19 patients; and (5) waived certain requirements for long term care hospitals (LTCHs). This PDF is Since Medicare does not have a pediatric population to consider when establishing alternative reimbursements for new high-dollar technologies, the ASD(HA) has therefore determined it is not practicable to use Medicare's NTAPs for pediatric patients; instead, the NTAP adjustment should be modified to address the unique TRICARE beneficiary population of pediatric patients. TRICARE uses the TRICARE Severity DRG payment system, which is modeled on the Medical Severity DRG payment system. Section 718(d) of the National Defense Authorization Act of 2017 authorized the Secretary of Defense to reduce or eliminate copayments or cost-shares when deemed appropriate for covered beneficiaries in connection with the receipt of telehealth services under TRICARE. This includes military, network, or non-network TRICARE-authorized providers. A Notice by the Indian Health Service on 12/31/2020. Expiration of Medicare's Hospitals Without Walls Initiative. documents in the last year. ) of this section. Please see our table below for reimbursement rate data per CPT code in 2022, 2021, and 2020. A total of four comments were received. Termination of this provision will save the DoD $4.8M for every month it expires prior to the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients. Do you need to check your TRICARE health plan enrollment? If yes, then you should contact the DHA Prime Travel Benefit office. 6 These account for the unique cost of providing care in that geographic area. Telephonic office visits were an average 2.1 percent of all telehealth services provided. Downtown Frankfurt: 3.20 km in a straight line. These markup elements allow the user to see how the document follows the New Documents 98% of claims must be paid within 30 days and 100% . 03/03/2023, 43 documents in the last year, 822 The first IFR, published in the FR on May 12, 2020 (85 FR 27921), temporarily: (1) Modified the TRICARE regulations to allow for coverage of medically necessary telephonic (audio-only) office visits; (2) permitted interstate and international practice by TRICARE providers when such practice was permitted by state, federal, or host-nation law; and (3) waived cost-shares and copayments for covered telehealth services for the duration of the COVID-19 pandemic. This repetition of headings to form internal navigation links on ( Our data is encrypted and backed up to HIPAA compliant standards. ) The CMS designated percentage of the estimated costs of the new technology or medical service, as published in 42 CFR 412.88; or. for better understanding how a document is structured but This section was last permanently modified on February 15, 2019 (84 FR 4333), as part of the final rule implementing the TRICARE Select benefit plan. A grouper program classifies each case into the appropriate DRG. Doing Business with the Defense Health Agency, Defense Medical Readiness Training Institute, Defense Health Program Agency Financial Report, 2020 DOD Womens Reproductive Health Survey (WRHS), Conducting Health Care Surveys in the DOD, Transition from CAHPS Version 4.0 to Version 5.0, TRICARE Inpatient Satisfaction Surveys (TRISS), 2018 Health-Related Behaviors Survey (HRBS), 2015 Health-Related Behavior Survey Active Duty, 2014 Health Related Behavior Survey of Reserve Component Leadership Fact Sheet, 2011 Health-Related Behavior Survey Active Duty, 2009 Health-Related Behavior Survey - Reserve Component, Clinical Improvement Priorities for MTF Providers, Small Market and Stand-Alone MTF Organizations, Defense Health Agency Region Indo-Pacific, Comprehensive Changes to the Autism Care Demonstration, Applied Behavior Analysis Maximum Allowed Amounts, Blend Rate Method for Radiology for Cancer and Children's Hospitals, TRICARE CHAMPUS ASA and DRG Weights Summary, TRICARE Rate Variables and Cost-Share Per Diems, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Limits on Number of Services without Override Code, Mental Health and Substance Use Disorder Facility Rates, Military Medical Support Office at DHA, Great Lakes, Information for Patients: TRICARE Pharmacy Program, Information for Pharmaceutical Manufacturers, Contact the TRICARE Retail Refund Team and FAQs, Opioid Overdose Education and Naloxone Distribution Program, DHA Pharmacy Operations Support Contract Data Management Team, Prescription Drug Monitoring Program Procedures, Quality, Patient Safety & Access Information (for Patients), Quality & Safety of Health Care (for Health Care Professionals), Eliminating Wrong Site Surgery and Procedure Events, The Global Trigger Tool in the Military Health System Guide, Patient Safety & Quality Academic Collaborative, Patient Safety Champion Recognition Program, Armed Forces Billing and Collection Utilization Solution, Health Plan and Policy Billing Guidelines, Health Insurance Portability and Accountability Act, UBO Standard Insurance Table (SIT)/Other Health Insurance (OHI), Air Force Wounded Warrior Northeast Warrior CARE Photo Essay, Ensuring Access to Reproductive Health Care, Military Acute Concussion Evaluation 2 (MACE 2), ABACUS Custom Tools Reports_Webinar Posttest, ABACUS Electronic Billing_Webinar Posttest, DHA UBO Webinar ABACUS Custom Tools Reports, DHA UBO Webinar_ABACUS Electronic Billing, ABA Maximum Allowed Rates Effective May 1 2022, 2000-2022 Q3 DOD Worldwide Numbers for TBI, 5 MinuteConsult Mobile App & CME Instructions, ClinicalKey for Nursing Clinical Updates CE Instructions, Applied Behavioral Analysis Maximum Allowed Amounts, Mental Health and Substance Use Disorder Facility List, Calendar Year 2022 TRICARE Prime and TRICARE Select Out-of-Pocket Costs: Active Duty Family Members, Calendar Year 2022 TRICARE Prime and TRICARE Select Out-of-Pocket Costs: Retired Service Members, Their Families, and Others, Memorandum to Establish 2022 Premium Rates, 2020 Billing Rates for Care Provided to Foreign Nationals, TRICARE Prime and TRICARE Select Out-of-Pocket Expenses for Calendar Year 2020, 2019 Billing Rates for Care Provided to Foreign Nationals, 2019 Monthly Premium Rates for TRS, TRR, and TYA, Policy Memorandum to Establish 2018 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve, Policy Memorandum to Establish Calendar Year 2018 Premium Rates for the TRICARE Young Adult Program, Memorandum to Establish 2017 TRICARE Reserve Select and TRICARE Retired Reserve Rates, Memorandum to Establish 2017 Premium Rates for the TRICARE Young Adult Program, Memorandum: Medical Billing Rates for Other Than Foreign Nationals 2016, Memorandum: Medical Billing Rates for Foreign Nationals 2016. During the conversation the provider will ask questions regarding the symptoms and determine if they can proceed with the telephonic office visit or if based on the information he/she reported, a face-to-face, hands-on visit is in fact medically necessary. The OFR/GPO partnership is committed to presenting accurate and reliable Beneficiaries will be impacted by the permanent addition of telephonic office visits, the elimination of the telehealth cost-share/copayment waivers, increased access to new technologies afforded by the pediatric NTAPs reimbursement methodology, and increased access to acute care in temporary hospitals. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. Only official editions of the Please consult the TRICARE Policy / Reimbursement Manuals to determine TRICARE benefits and coverage. documents in the last year, 86 erica.c.ferron.civ@mail.mil. See 199.4. 1W$&98'qN9[=EA%x0Pa0 NTAP Pediatric Reimbursement Methodology. Doing Business with the Defense Health Agency, Defense Medical Readiness Training Institute, Defense Health Program Agency Financial Report, 2020 DOD Womens Reproductive Health Survey (WRHS), Conducting Health Care Surveys in the DOD, Transition from CAHPS Version 4.0 to Version 5.0, TRICARE Inpatient Satisfaction Surveys (TRISS), 2018 Health-Related Behaviors Survey (HRBS), 2015 Health-Related Behavior Survey Active Duty, 2014 Health Related Behavior Survey of Reserve Component Leadership Fact Sheet, 2011 Health-Related Behavior Survey Active Duty, 2009 Health-Related Behavior Survey - Reserve Component, Clinical Improvement Priorities for MTF Providers, Small Market and Stand-Alone MTF Organizations, Defense Health Agency Region Indo-Pacific, Comprehensive Changes to the Autism Care Demonstration, Applied Behavior Analysis Maximum Allowed Amounts, Blend Rate Method for Radiology for Cancer and Children's Hospitals, TRICARE CHAMPUS ASA and DRG Weights Summary, TRICARE Rate Variables and Cost-Share Per Diems, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies, Limits on Number of Services without Override Code, Mental Health and Substance Use Disorder Facility Rates, Military Medical Support Office at DHA, Great Lakes, Information for Patients: TRICARE Pharmacy Program, Information for Pharmaceutical Manufacturers, Contact the TRICARE Retail Refund Team and FAQs, Opioid Overdose Education and Naloxone Distribution Program, DHA Pharmacy Operations Support Contract Data Management Team, Prescription Drug Monitoring Program Procedures, Quality, Patient Safety & Access Information (for Patients), Quality & Safety of Health Care (for Health Care Professionals), Eliminating Wrong Site Surgery and Procedure Events, The Global Trigger Tool in the Military Health System Guide, Patient Safety & Quality Academic Collaborative, Patient Safety Champion Recognition Program, Armed Forces Billing and Collection Utilization Solution, Health Plan and Policy Billing Guidelines, Health Insurance Portability and Accountability Act, UBO Standard Insurance Table (SIT)/Other Health Insurance (OHI), Air Force Wounded Warrior Northeast Warrior CARE Photo Essay, Ensuring Access to Reproductive Health Care, Military Acute Concussion Evaluation 2 (MACE 2), ABACUS Custom Tools Reports_Webinar Posttest, ABACUS Electronic Billing_Webinar Posttest, DHA UBO Webinar ABACUS Custom Tools Reports, DHA UBO Webinar_ABACUS Electronic Billing, ABA Maximum Allowed Rates Effective May 1 2022, 2000-2022 Q3 DOD Worldwide Numbers for TBI, 5 MinuteConsult Mobile App & CME Instructions, ClinicalKey for Nursing Clinical Updates CE Instructions, FY 2013, FY 2014, and FY 2015 Final HAC List, DRGs Subject to Device Replacement Policy for Hospital Admissions on or after Oct. 1, 2009, For questions or more information about rates, policies, etc., please contact your, To learn more about DRG Rates, please visit the. Whether youre a physician, psychologist, or technician, you need to understand the reimbursement rates for psychological or neuropsych testing in 2022. LTCH Site Neutral Payments. publication in the future. This table of contents is a navigational tool, processed from the on You can use these rate differences as estimates on the rate changes for private insurance companies, however it's best to ensure the specific CPT code you want to use is covered by insurance. All AGR records and TRICARE health plans should be corrected and reinstated. Withholds participating hospitals payments by a percentage specified by law. Exceptions: (i) Medically necessary and appropriate Telephonic office visits are covered as authorized in paragraph (c)(1)(iii) of this section. For context, this section also provides updated cost estimates for temporary benefit and reimbursement changes implemented in prior IFRs that are finalized in this FR ($278.0M through September 30, 2022), including the telehealth cost-share/copayment waiver being terminated by the FR (estimated cost $149.7M through September 30, 2022), and updated cost estimates associated with permanent reimbursement changes implemented in prior IFRs that are finalized in this FR ($13.0M through FY24). We will also respond to comments related to TRICARE's third IFR published in 2020 in a future final rule. The approved TRICARE NTAPs shall be published at least annually on the website: Table of Contents TRICARE Reimbursement Manual 6010.55-M, August 2002, Change 159 (April 3, 2013) TOC Foreword Introduction Chapter 1 -- General Chapter 2 -- Beneficiary Liability Chapter 3 -- Operational Requirements Chapter 4 -- Double Coverage Chapter 5 -- Allowable Charges Chapter 6 -- Diagnostic Related Groups (DRGs) Chapter 7 -- Mental Health FDA-approved at-home antigen rapid diagnostic test kits may be covered with a physician's order. Start Printed Page 33004 . . daily Federal Register on FederalRegister.gov will remain an unofficial The IFR permanently added coverage of Medicare's NTAP payments for new medical services, adding an additional payment to the DRG payment for new and emerging technologies approved by Medicare. This amount will vary depending on the number of new NTAPs adopted by Medicare each year, the extent to which Medicare-identified emerging technologies are covered under TRICARE's statutory and regulatory requirements, and the extent to which TRICARE's population utilizes these technologies. The HVBP Program was implemented retroactive to January 1, 2020; we anticipated that those hospitals qualifying for a positive adjustment for prior claims would do so, while those with negative adjustments or adjustments close to zero dollars would not. We appreciate the feedback from the commenter regarding a 20 percent increase for acute inpatient reimbursement for SCHs treating COVID-19 patients. To address the unique TRICARE beneficiary population of pediatric patients, this rule establishes reimbursement of pediatric NTAPs at 100 percent of the costs in excess of the MS-DRG payment. 50% of the amount by which total covered costs exceed the Medicare Severity (MS)-DRG payment, or. Allowable Charges for TRICARE's most frequently used procedures. The public comments regarding the temporary exception to the regulatory exclusion prohibiting telephone services were minimal. offers a preview of documents scheduled to appear in the next day's Telephonic office visits are also highly desirable for beneficiaries who reside in rural areas and/or areas where health care services are scarce. www.health.mil/ntap. These amounts are the only new costs associated with the FR ( About the Federal Register This final rule finalizes the cost-share/copayment waiver provision as written in the IFR, except that it now terminates on the effective date of this rule, or the date of termination of the President's national emergency for COVID-19, whichever is earlier.