• Expanding the age for work requirements from 18-49 to 18-65
• Closing the “loophole” that allows states to request more work requirement waivers if the number of available jobs for SNAP enrollees is less than the number of unemployed enrollees
• Requiring enrollees and states to renew their work requirement waivers annually.

• General requirements
• For non-exempt recipients aged 16-59 – often families or those with children
• Must register for work or job training. They must take any suitable job that is offered, and they may not voluntarily quit their job or reduce their hours without good reason. Some states may require assigned employment or training programs.
• Able-bodied adults without dependents (ABAWDs) requirements: 
• Adults who are eligible to work and do not have dependent children  
• Must participate in job training or work at least 80 hours per month (20 hours per week) to receive SNAP for longer than three months within a three-year time limit

• If an ABAWD misses their work or training requirement for three months, they will become ineligible and be cut off from benefits for the remainder of this three-year time limit
• Time limits were suspended during the height of the pandemic but will be reinstated this May
• States can request waivers that exempt enrollees from the time limit if they have an unemployment rate of at least 10% or there are more enrollees than there are available jobs.  

• Allowing use and disclosure of protected health information by business associates for public health oversight;
• Enforcement of COVID-19 community-based testing during the PHE;
• Not enforcing noncompliance with online scheduling applications for a COVID-19 vaccine appointment; and
• Enforcement of telehealth remote communications
• HHS’ Office of Civil Rights will provide a 90-day transition period to exercise its enforcement of remote telehealth communications until August 9, 2023.

• CDC established a new program for COVID-19 to tackle this serious health threat. They modernized their approach to tracking coronaviruses and other respiratory threats and revamped immunization programs.
• CDC is actively working with other federal government agencies and offices to maintain equitable access to vaccines, testing, and therapeutics to the extent possible.
• CDC is working with other federal agencies, as well as academic institutions and research organizations, to learn more about the short- and long-term health effects associated with COVID-19, who is affected, and why.

• Most CDC COVID-19 data activities are not directly affected by the PHE (e.g., case and death reporting, national genomic surveillance, sentinel surveillance, wastewater surveillance, traveler genomic surveillance).
• Hospital data reporting will continue through April 30, 2024, but reporting may be reduced from the current daily reporting to a lesser frequency. Additional details are provided below.
• CDC, along with jurisdictional partners, is assessing ongoing surveillance needs and potential revisions to surveillance systems to efficiently continue tracking COVID-19 after the PHE ends and will share more information when available.
• The end of a public health emergency does not equate to the end of the current national vaccine distribution program or the availability of vaccine commercially. CDC has received many questions regarding commercializing COVID-19 vaccines. They continue to work with HHS on this process and are collecting questions to help ensure they address the needs of jurisdictions and partners.
• CDC’s Amended Order Implementing Presidential Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic will remain in effect until terminated by the president. It is implemented under a Presidential proclamation, Advancing the Safe Resumption of Global Travel During the COVID-19 Pandemic.

• Context: Ending the PHE declaration would revoke the CARES Act authority for HHS to require laboratory result reporting. This could result in states and local authorities receiving less consistent and comprehensive of SARS-CoV-2 laboratory result data, which could also affect the quality of the data reported to CDC).
• The change would likely primarily affect negative result reporting since laboratories and healthcare providers may still be required to report positive cases, depending on state and local laws or regulations.
• This may impact speed of reporting, as case reporting can often lag behind test reporting data.
• The change would not affect calculation of CDC COVID-19 Community Levels, but would impact the percent positivity metric used to understand Transmission Levels. Transmission Levels are used by hospitals, as mandated by Centers for Medicare & Medicaid Services (CMS) to determine prevention measures/mitigation strategies.
• Impacts
• Percent positivity metric will likely no longer be available.
• COVID-19 Transmission Levels, used primarily for healthcare settings, would no longer be calculated, as they involve case and test positivity data.
• CDC is determining how to address healthcare guidance without use of Transmission Levels.

• Data Use Agreements (DUAs) for COVID-19 vaccine administration were established with termination provisions that reference the PHE. State and territorial public health jurisdictions are being asked to extend this DUA through the end of 2023:
• As of April 5, 2023, 57 jurisdictions have signed a COVID-19 DUA extension for weekly reporting, 4 jurisdictions will provide data quarterly as part of submission of routine vaccine administration data, and 3 jurisdictions have not signed any DUA to enable sharing of COVID-19 vaccine administration data after the end of the PHE.
• Impacts
• Receipt of vaccine administration data would be unaffected for those with signed DUAs with CDC to share data.
• CDC is discussing DUAs with other jurisdictions where they are not yet in place.
• CDC is aware that some state policies (i.e., opt-in policies) that were paused due to the PHE will likely be reinstated and may affect vaccination providers’ ability to report vaccine administration to the state immunization information system (IIS). This could result in incomplete data at the IIS.
• Without sharing of data from all jurisdictions, CDC will no longer have access to comprehensive data regarding who is being vaccinated. This will affect the ability to monitor implementation of vaccine recommendations, identify unvaccinated populations who may be susceptible to COVID-19, and evaluate vaccine effectiveness.

• CMS currently requires daily hospital reporting of COVID-19 and other data elements. CDC is working closely with CMS and the Administration for Strategic Preparedness and Response (ASPR) to determine which data elements remain critical for public health, preparedness, and patient safety following the conclusion of the PHE—and the frequency with which these need to be reported.
• More detail: CMS Conditions of Participation regulations currently require the current reporting of hospitalization data and bed occupancy to be reported to CDC every day during the PHE. In its FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule (CMS-1771-F) released in August 2022, CMS finalized a revision to the hospital and critical access hospital (CAH) infection prevention and control conditions of participation (CoP) requirements that require hospitals and CAHs, after the conclusion of the current COVID-19 PHE, to continue reporting on a reduced number of COVID-19 data elements. The revisions will apply upon conclusion of the COVID-19 PHE and continue through April 30, 2024, unless the Secretary establishes an earlier ending date.   
• Impacts
• CDC is working closely with CMS and ASPR to determine which data elements remain critical for public health, preparedness, and patient safety following the conclusion of the PHE—and the frequency with which these need to be reported.
• CDC will share any guidance related to reporting requirement changes when they are issued by CMS. 
• Certain changes in hospitalization reporting might affect calculation of the COVID-19 Community Levels

• The ending of the PHE may limit the ability for the CDC Increasing Community Access to Testing (ICATT) for COVID-19 (cdc.gov) program to provide no-cost COVID-19 testing for communities who are at a greater risk of being impacted by the pandemic and people without health insurance.
• Current federal agreements between pharmacies and ICATT will allow for continued no-cost COVID-19 testing of people who are uninsured; Although, the ICATT may have a reduction in COVID-19 testing locations after the PHE ends. 
• ICATT pharmacy and surge testing vendors are funded for 6-month increments. Contracts are currently funded through May 2023. Funding beyond May 2023 will be announced as information becomes available.
• Impacts
• Changes in insurance reimbursement policies may reduce the number of ICATT vendor sites offering testing.
• CDC will continue to support testing for people who are uninsured through the ICATT program, although testing access may be reduced if fewer testing sites are available.
• Please send questions regarding ICATT to ICATTProgram@cdc.gov. 

• National Key Server (NKS) and Multi-tenant Verification Server (MVS) Operations
• Exposure Notifications Express (ENX) Solution

• Provides Critical Nutrition to Children, Seniors, and Families: Provides $6.3 billion to fully fund WIC and $15 billion over ten years to expand the Community Eligibility Program, which provides free school meals to 9 million children
• Strengthens the Supplemental Nutrition Assistance Program (SNAP): Highlights the Farm Bill as an opportunity strengthen SNAP by doing away with time limits, increasing cross enrollment capabilities, and expanding food purchasing options to include more healthy choices
• Provide Better Care for All Americans: Provides $1.7 billion to expand Medicaid and Medicare’s nutrition and obesity counseling coverage
• Makes the Healthy Choice the Easy Choice: Invests $478 million in the FDA’s Center for Food Safety and Applied Nutrition to improve food labeling and $26 million to raise awareness of dietary and physical activity guidelines
• Builds Communities That Promote Physical Activity: Invests $130 million into the CDC’s Division of Nutrition, Physical Activity, and Obesity, which runs State Physical Activity and Nutrition (SPAN) programs, which aim to make physical activity safer and more accessible
• Connects More Americans to Parks: Invests $7 million in the National Parks Service to create transit opportunities to provide equal access to parks and green spaces
• Builds the Foundation for Evidence-Based Policies: Invests $121 million in nutrition research to create evidence-based policies