The Biden administration’s decision to end the COVID-19 public health emergency in May will institute sweeping changes across the health care system that go far beyond the fact that many people have to pay more for COVID testing.

In response to the pandemic, the federal government suspended many of its rules on how care was delivered in 2020. This has essentially transformed every corner of American healthcare, from hospitals and nursing homes to public health and care for people recovering from addiction.

Now, as the government prepares to reverse some of these steps, here’s a taste of the ways patients will be impacted.

Training rules for nursing home staff become stricter

The end of the emergency means that care homes will have to meet higher standards for staff training.

Advocates for nursing home residents are eager to see the old, stricter training requirements reinstated, but the industry says the relocation could worsen the staffing shortages plaguing facilities nationwide.

In the early days of the pandemic, to help nursing homes function under the onslaught of the virus, the federal government relaxed training requirements. The Centers for Medicare & Medicaid Services has instituted a national policy that nursing homes must not follow regulations requiring nurse assistants to undergo at least 75 hours of state-approved training. Normally, a nursing home might not employ caregivers for more than four months unless they meet these requirements.

Last year, CMS decided that relaxed training rules would no longer apply nationwide, but states and facilities could seek permission to be held to lower standards. As of March, 17 states had such exemptions, according to CMS Georgia, Indiana, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, New Jersey, New York, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Vermont and Washington as well as 356 individual nursing homes in Arizona, California, Delaware, Florida, Illinois, Iowa, Kansas, Kentucky, Michigan, Nebraska, New Hampshire, North Carolina, Ohio, Oregon, Virginia, Wisconsin and Washington, DC

Nursing assistants often provide the most direct and labor-intensive care for residents, including bathing and other hygiene-related tasks, feeding, monitoring vital signs, and cleaning rooms. Research has shown that care homes with unstable staff maintain a lower quality of care.

Nursing home resident advocates are glad that exceptions to training will end, but fear that the quality of care could still deteriorate. That’s because CMS has signaled that, after the looser standards expire, some of the hours logged by nurse assistants during the pandemic could count towards their 75 hours of required training. Workplace experience, however, isn’t necessarily a viable substitute for the education workers lose, advocates argue.

Proper training of caregivers is critical so they know what they are doing before providing care, for their own good as well as residents, said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.

The American Health Care Association, the largest nursing home lobby group, released a December survey finding that about 4 out of 5 facilities were dealing with moderate to high levels of staffing shortages.

Threatened treatment for people recovering from addiction

A looming rollback of wider access to buprenorphine, an important drug for people recovering from opioid addiction, is alarming patients and doctors.

During the public health emergency, the Drug Enforcement Administration said providers could prescribe certain controlled substances virtually or over the phone without first conducting an in-person medical evaluation. One such drug, buprenorphine, is an opioid that can prevent debilitating withdrawal symptoms for people trying to recover from addiction to other opioids. Research has shown that its use more than halves the risk of overdose.

Amid a nationwide epidemic of opioid addiction, if the expanded buprenorphine policy ends, thousands will die, said Ryan Hampton, a recovering activist.

The DEA in late February proposed regulations that would partially reduce the prescribing of controlled substances through telehealth. A doctor could use telehealth to order an initial 30-day supply of drugs like buprenorphine, Ambien, Valium and Xanax, but patients would need an in-person evaluation to get a refill.

For another group of drugs, including Adderall, Ritalin and oxycodone, the DEA proposal would institute stricter controls. Patients seeking those drugs should see a doctor in person for an initial prescription.

David Herzberg, a drug historian at the University at Buffalo, said the DEA’s approach reflects a fundamental challenge in drug policy development: meeting the needs of people who rely on an abuseable drug without making it too readily available to others.

The DEA, he added, is clearly grappling seriously with this problem.

The hospitals somehow return to normal

During the pandemic, CMS has tried to limit the problems that could arise if there weren’t enough healthcare workers to treat patients, especially before COVID vaccines existed, when workers were most at risk of getting sick.

For example, CMS has enabled hospitals to make greater use of nurse practitioners and physician assistants when caring for Medicare patients. And new doctors not yet accredited to work at a particular hospital, for example, because governing bodies didn’t have time to conduct their reviews could still practice there.

Other changes during the public health emergency were intended to strengthen hospital capacity. Critical access hospitals, small hospitals located in rural areas, did not have to comply with federal rules for Medicare which stated that they were limited to 25 hospital beds and patient stays could not exceed 96 hours, on average.

Once the emergency ends, those exceptions will disappear.

Hospitals are trying to get federal officials to keep multiple COVID-era policies beyond the emergency or work with Congress to change the law.

Infectious Disease Surveillance Splinters

The way state and local public health departments monitor the spread of the disease will change after the emergency ends, because the Department of Health and Human Services will not be able to require laboratories to report COVID test data.

Without a uniform federal requirement, how states and counties monitor the spread of the coronavirus will vary. Also, while hospitals still provide COVID data to the federal government, they may do so less frequently.

Public health departments are still considering the extent of the changes, said Janet Hamilton, executive director of the Board of State and Territory Epidemiologists.

In a way, the end of the emergency provides an opportunity for public health officials to rethink COVID surveillance. Compared to the early days of the pandemic, when home testing wasn’t available and people relied heavily on labs to determine if they were infected, lab test data now reveals less about how the virus is spreading.

Public health officials no longer think that getting all test results from all lab tests is potentially the right strategy, Hamilton said. Influenza surveillance provides a potential alternative model: For influenza, public health departments look for test results from a sample of laboratories.

We’re still trying to figure out what the best and most consistent strategy is. And I don’t think we have it yet, Hamilton said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a gifted non-profit organization that provides information on health issues to the nation.