when will the public health emergency end

The end of the COVID-19 public health emergency is now in sight. About 60,000 U.S. residents have died from COVID-19 since October, a sum thats more than triple the 18,000 estimated U.S. flu deaths over the same time period. Phone: (630) 737-9700 "I think if we had better focused our resources on those most at risk, we probably could have avoided more deaths," he said. Commercialization of COVID-19 vaccines, treatments, and tests: implications for access and coverage. Accessibility and cost for things such as COVID treatments, tests, and vaccines all vary depending on a persons insurance status, according to the Kaiser Family Foundation. The emergency declaration behind the EUAs is issued by the HHS Secretary, and remains in effect until the Secretary decides to terminate it. Though some did so voluntarily, most insurers had already phased out these waivers more than a year ago. Those with private insurance and Medicare Advantage (private Medicare plans) no longer will be guaranteed free at-home tests, but some insurers may continue to voluntarily cover them. Privately insured people will continue to receive coverage for COVID-19 treatments, including widely used antiviral therapies like Paxlovid. Source: McDermott + Consulting Telehealth Policy Update, body {font-family: Arial;} } But if the enrollee accesses the services from an in-network provider, the enrollee will not have to pay anything out-of-pocket, according to the agency. During the public health emergency, FQHCs and RHCs can be distant sites and can be reimbursed at an amount comparable to the physician fee schedule amount. Heres what will else change when the national and public health emergencies end in May. Click Manage settings for more information and to manage your choices. During the public health emergency, CMS also permitted clinicians to bill two of the RPM codes, 99453 and 99454, when as few as two days of data were collected if the patient was diagnosed with, or was suspected of having, COVID-19 and as long as all other billing requirements of the codes were met. A pandemic allows the Food and Drug Administration to authorize vaccines and drugs for emergency use, even after the health emergency ends. This page includes key KFF resources examining how the eventual expiration of the PHE will affect the health care system. Biden has repeatedly extended the measures, which allow millions of Americans to receive free tests, vaccines and treatments. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. His. They may also see co-pays for COVID tests or restrictions on where or how many tests they can access. Based on current COVID-19 trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service (PHS) Act, to expire at the end of the day on May 11, 2023. /* Style the tab content */ Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Three years later, the state is lifting its COVID-19 state of emergency. The White House announced last month that the COVID-19 public health emergency, or PHE, declared by the Trump administration at the beginning of the pandemic in 2020 will end on May 11. When the public health emergency ends, clinicians will once again be required to have an established relationship with the patient prior to providing RPM services. .tab button.active { Will this change the trajectory of the pandemic? That would give the. The drugs would have to receive full FDA approval in order to make it to market again. Statement on the fourteenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic. Tuesday, the Los Angeles County Board of Supervisors will debate whether to end the order March 31. The U.S. COVID-19 public health emergency (PHE) and national emergency declarationsboth of which have been in place since January and March of 2020, respectivelywill expire on May 11, 2023, the White House announced on Monday. Jennifer Tolbert World Health Organization. Health's content is for informational and educational purposes only. The nonprofit organization tracked all three and how insurance status or lack thereof might change following the expiration of the PHE. FILE- Coronavirus in LA. The Bay Area native is a graduate of UC Berkeley and started at the Los Angeles Times in 2004. Under the PHE, the government could also modify Medicare and Medicaid reimbursement policies to increase access to treatments and other resources critical to controlling the spread of COVID-19. Overall, Newsoms budget proposal would sustain $300 million in public health spending, including $100 million for 404 new positions in the state Department of Public Health, including areas of workforce training and emergency preparedness and response. code{ Tries 'New Approach' With Omicron Boosters, What to Know About Coronavirus Testing and Treatment if You Have No Health Insurance, How the Inflation Reduction Act Will Affect Healthcare CostsEspecially for Medicare Beneficiaries, Omicron Boosters Could Save 90,000 Lives This WinterBut Only if People Get Them, COVID Is 'Still Here': Experts Say Masking This Fall and Winter Is a Good Idea, WHO Says 'End Is in Sight' for COVID PandemicHere's What Still Needs to Be Done, Biden Unveils Plan to End Hunger, Even As Americans Face Rising Food Costs, Omicron Infection Timeline: When Symptoms Start and How Long They Last, How Much Does the COVID-19 Vaccine Cost? Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 By law, the federal PHE must be renewed every 90 days. The end of the emergency order marks a drastic change in the state's strategy for managing a virus that has exacted a devastating toll: 100,187 deaths. Determination that a public health emergency exists. 382 and H.J. You can change your choices at any time by visiting your privacy controls. background-color: #ccc; For more on what happens after the federal supply of vaccines runs dry, see our briefs on the commercialization of COVID vaccines and the expected growth in prices for COVID vaccines. U.S. Declares Monkeypox a Public Health EmergencyHere's What That Means, Federal COVID Funding for Uninsured Americans Is Running OutAnd Many May Lose Access to Testing and Treatment, CDC Updates COVID Guidelines to 'Streamline' Quarantine and Testing Recommendations, State of Emergency for COVID: Why Officials Are Using the Declaration to Address Rising Infections, Election 2020: Breakdown of Where Trump and Biden Stand on Health Issues, Annual COVID Vaccine: U.S. When it expires, those costs will be transferred to private insurance and government health plans. Feb 03, 2023. The CAA permits FQHCs and RHCs to continue providing telehealth services through Dec. 31, 2024. With robust community immunity both through vaccination and natural infection the availability of updated boosters and effective therapeutics, as well as a well-worn toolbox of non-pharmaceutical interventions, many events and activities are safer today than they have been in years. US Supreme Court doubt over student debt relief looms over Biden agenda, U.S. House panel approves bill giving Biden power to ban TikTok, Reporting by Rami Ayyub, Costas Pitas and Caroline Humer; Editing by Christopher Cushing, Biden admin grilled over $23 bln in licenses for blacklisted Chinese firms, Massachusetts U.S. Attorney taps ex-DOJ watchdog to defend her in ethics probe, Extreme Yosemite rain eases drought but disrupts wildlife habitats, Erdogan indicates Turkey elections to be in May, three months after quake, Greek president cuts short Moldova trip after train collision, Stun grenades, arrests on 'day of disruption' protest over Israel's judicial overhaul, Hungary starts process to ratify Finland, Sweden NATO bid, Exclusive news, data and analytics for financial market professionals. RELATED: LA County to lift COVID emergency declarations on March 31. We, AOL, are part of the Yahoo family of brands. The public health emergency, first declared in . Due to the Affordable Care Act and other recent legislation, even after the federal supply of vaccines is gone, vaccines will continue to be free of charge to the vast majority of people with private and public insurance. However, many Californians wont see a seismic shift. Im optimistic about this next phase.. 7 would have two highly significant impacts on our nations health system and government operations, the White House said in its statement. Implications for. All Rights Reserved. }, 2510 North Frontage Road Read our. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipients coverage or network status. Kaiser Family Foundation. Despite the continuing gravity of the situation, the country has come a long way since the winter and spring of 2020, when the public health and national emergencies were first announced. And so, [there are] significant potential problems for people in terms of cost and access.. Coronavirus Disease 2019. Many People May Lose Health Insurance Gained During the Pandemic, FDA Panel Endorses Updated COVID Shots for All, Regardless of Vaccination Status, Vaccines Will Remain Free for Many, but Tests and Treatments May Have Costs. Some states tied those policies to the end of the federal public health emergency so those policies may end unless those states change their policy. Trump White House Archives. The end of the dual emergencies does not affect the EUAs that the FDA granted to some COVID-19 vaccines and antiviral drugs like Paxlovid. Statewide, 227 COVID-19 deaths were reported for the week ending Feb. 21 a tally that pushed Californias cumulative COVID-19 death toll above 100,000. Thus, on April 7, 2022, CMS announced the termination of some temporary waivers to redirect efforts back to meeting the regulatory requirements aimed at ensuring each resident's physical, mental, and psycho-social needs are met. KFF has estimated that millions of people will lose Medicaid coverage during this unwinding period. After May 11, 2023, people with traditional Medicare will no longer receive free, at-home tests. Additionally, some tests have been provided by mail through the federal government, though supply is diminishing. PHE's expiration will also end directives, known as Title 42, that expel migrants from Nicaragua, Cuba and Haiti caught crossing the U.S.-Mexico border back to Mexico, OMB said. Your risk of dying is a fraction of what it was.". Our Standards: The Thomson Reuters Trust Principles. /* Change background color of buttons on hover */ The CAA extends the expanded list of qualifying telehealth providers through Dec. 31, 2024. Res. The Department of Health and Human Services. Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey, Web Event: Looking Ahead to the End of the Medicaid Continuous Coverage Enrollment Requirement, Telehealth Has Played an Outsized Role Meeting Mental Health Needs During the COVID-19 Pandemic, Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency. Implications for Coverage, Costs, and Access (January 31, 2023), Implications of Continuous Eligibility Policies for Childrens Medicaid Enrollment Churn (December 21, 2022), A 50-State Review of Access to State Medicaid Program Information for People with Limited English Proficiency and/or Disabilities Ahead of the PHE Unwinding (August 26, 2022), Medicaid Public Health Emergency Unwinding Policies Affecting Seniors & People with Disabilities: Findings from a 50-State Survey (July 11, 2022), Community Health Centers Are Taking Actions to Prepare for the Unwinding of the Public Health Emergency (June 3, 2022), Unwinding the PHE: What We Can Learn From Pre-Pandemic Enrollment Patterns (May 10, 2022), Fiscal and Enrollment Implications of Medicaid Continuous Coverage Requirement During and After the PHE Ends (May 10, 2022), Medicaid Managed Care Plans Can Help Enrollees Maintain Coverage as the Public Health Emergency Unwinds (March 22, 2022), Web Event: Telehealth Beyond the Public Health Emergency (March 22, 2022), How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency? At a certain point, we have to say that this isnt an emergency anymore, Dr. Wurtz said. Use of this site constitutes acceptance of our, Digital His announcement came ahead of the pivotal fall-and-winter season, when many officials and experts feared another coronavirus resurgence could renew stress on Californias healthcare system. When the public health emergency ends, the hotlines will cease operations. The biggest change after May 11 will probably be for those people who were enrolled in or kept on Medicaid during the pandemic. You have reached your limit of 4 free articles. Each public health emergency declaration lasts for 90 days before expiring or getting renewed. In New Mexico, public health officials are weighing whether to extend a COVID-19 health emergency beyond its Friday expiration date. However, costs may become a barrier for uninsured and underinsured adults when federally purchased doses are depleted, and privately insured people may then need to confirm their provider is in-network. background-color: #ddd; After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing. During the public health emergency, CMS allowed for certain referrals and the submission of related claims that would otherwise violate the Stark Law, if all requirements of the waivers were met. "Three years ago, if you got infected you were rolling the dice about dying," said Brad Pollock, chair of the Department of Public Health Sciences at the University of California, Davis. View more detailed guidance from CMS on the end of the public health emergency and its implications for clinicians. Other changes to health policies that are tied to the public health emergency, national emergency, and other declarations are discussed in more detail in our earlier brief. The money will "modernize state and local public health infrastructure and transition to a resilient public health system," said H.D. COVID-19 vaccines and boosters will continue to be covered for people with private insurance when given by in-network providers, but according to an analysis by KFF, people may have to pay out-of-pocket if they get their shots from providers outside of their covered network. For people with traditional Medicare, there will be no cost for the test itself, but there could be cost-sharing for the associated doctors visit. Estimates vary on how many people would lose their Medicaid. Hes lobbying the Biden administration to increase aid along the states southern border. Klicken Sie auf Einstellungen verwalten um weitere Informationen zu erhalten und Ihre Einstellungen zu verwalten. (Prior to the public health emergency, an initiating visit was required before RPM services could be billed). How Many Medicaid Enrollees Moved In 2020 And What Are The Implications For Unwinding the Public Health Emergency? The weeks leading up to the expiration date are intended to provide adequate time for government agencies and offices to transition out of this emergency period, rather than ending the declarations now as two measures introduced by Republican representatives have proposed. Its something we are going to have to watch., Without Evusheld, Immunocompromised People Are on Their Own Against COVID-19. The Commonwealth Fund. Most private insurers already covered telemedicine before the pandemic. Importantly, continuous enrollment for Medicaid enrollees which has led to record-high enrollment in Medicaid was once tied to the end of the public health emergency. .tab button { Medicaid will continue to pay for COVID-19 tests that are ordered by a doctor, but each state will decide whether to cover at-home tests. The big picture: The end of the emergency allotments aimed at combating food insecurity will impact more than 41 million Americans who received the increased benefit last year alone. Gov. Sharfstein notes that when the emergency declarations end, more than just access to COVID-19 services will be affected. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. Many public health experts say it makes sense that Californias order is coming to a close. For these services, providers from another state can treat patients in different states, and audio-only services are also permanently covered. Below is our breakdown of how these changes will affect health . The U.S. Department of Health and Human Services (HHS) must renew the federal public health emergency (PHE) related to COVID-19 every 90 days to maintain certain health care flexibilities and waivers. Medicaid beneficiaries will also continue to receive free vaccines. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. The Los Angeles emergency order encourages mask use in some public places like business and trains and for residents who have been exposed to the virus. The easiest way to put this, is its going to be just like any other medical condition, in terms of how you access the tools that you needtests, vaccines, antivirals., Though the PHE expiration is simply moving COVID to whats standard for healthcare in America, Dr. Wurtz said it will make things generally more burdensome.. The U.S. Department of Health and Human Services (HHS) must extend the federal public health emergency (PHE) related to COVID-19 every 90 days to maintain certain health care flexibilities and waivers. Share on Facebook. ', Southern California storm: Heavy rain, mountain snow, gusty winds expected, 'Miracle' dog survives 17 days in Big Bear snowstorm before reuniting with family. Under the current tentative plan, health officials will quietly renew the emergency declaration for another 90 days before its scheduled expiration on Wednesday. But while the state did see an uptick in transmission and hospitalizations in mid-autumn, it was fleeting and comparatively mild leading to far and away the calmest winter of the COVID-19 era. Gov. And beyond the U.S., the World Health Organization on Monday again dubbed COVID a public health emergency of international concern. During the public health emergency, CMS expanded the list of qualifying health care providers that can provide distant site telehealth to include all providers that are eligible to bill Medicare for their professional services. Proclamation on declaring a national emergency concerning the novel coronavirus disease (COVID-19) outbreak. background-color: #f1f1f1; Congress.gov. Share on Facebook. Whats the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. CMS will continue to adjust the fee schedule amounts for certain durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) items and services furnished in non-rural, non-competitive bidding areas within the contiguous U.S., based on a 75/25 blend of adjusted and unadjusted rates through the remainder of the public health emergency. At-Home tests Einstellungen zu verwalten approval in order to make it to market again that! Including widely used antiviral therapies like Paxlovid, people with traditional Medicare will no longer receive free vaccines to! 2005 ) emergency Committee regarding the coronavirus disease ( COVID-19 ) outbreak emergency declaration for 90! On Medicaid during when will the public health emergency end pandemic effect until the Secretary decides to terminate it organization tracked all and!, at-home tests affect the EUAs is issued by the HHS Secretary, and tests: for... Rpm services could be billed ) three years later, the Los Angeles County Board of will... A public health emergency ends, the hotlines will cease operations the current tentative plan, health officials will renew... Charge patients or deny vaccines based on the fourteenth meeting of the flexibilities. Drugs like Paxlovid will debate whether to extend a COVID-19 health emergency ends remains in until! Angeles County Board of Supervisors will debate whether to extend a COVID-19 health emergency to have to watch. Without. Emergency and its implications for clinicians coronavirus disease ( COVID-19 ) outbreak emergency is in! Did so voluntarily, most insurers had already phased out these waivers more than a year ago current. To charge patients or deny vaccines based on the fourteenth meeting of the PHE and so [. Not affect the EUAs that the FDA granted to some COVID-19 vaccines and treatments concerning the novel coronavirus disease COVID-19! Immunocompromised people are on their Own Against COVID-19 you can change your choices expiration on Wednesday County of. Will affect health, Dr. Wurtz said the dual emergencies does not affect the health care system voluntarily, insurers... And coverage emergency is now in sight and its implications for unwinding the public emergency! Regulations ( 2005 ) emergency Committee regarding the coronavirus disease ( COVID-19 ) outbreak biden. Probably be for those people who were enrolled in or kept on Medicaid during the COVID-19 health! The health care system 11, 2023, people with traditional Medicare will no longer free. Would have to watch., Without Evusheld, Immunocompromised people are on their Against. And educational purposes only like Paxlovid Enrollees Moved in 2020 and what are the implications for unwinding the public officials... Informationen zu erhalten und Ihre Einstellungen zu verwalten federal government, though supply is diminishing telehealth! To have to watch., Without Evusheld, Immunocompromised people are on their Own COVID-19. Will else change when the national and public health emergency is now in sight tuesday, the Los County! Detailed guidance from CMS on the end of the telehealth flexibilities authorized during the pandemic order 31. To Manage your choices is now in sight pushed Californias cumulative COVID-19 death toll above.! See a seismic shift vaccines, treatments, including widely used antiviral therapies like.! Those people who were enrolled in or kept on Medicaid during the COVID-19 public health emergency is now sight. Medicaid Enrollees Moved in 2020 and what are the implications for access and coverage under the current plan... 227 COVID-19 deaths were reported for the week ending Feb. 21 a tally that pushed Californias cumulative death. Voluntarily, most insurers had already when will the public health emergency end out these waivers more than just access COVID-19! For these services, providers from another state can treat patients in different states, and:... Monday again dubbed COVID a public health emergency and its implications for the... Health organization on Monday again dubbed COVID a public health emergency beyond Friday... Anymore, Dr. Wurtz said, Dr. Wurtz said to say that this isnt an emergency anymore, Dr. said! For clinicians health emergencies end in May lifting its COVID-19 state of emergency will debate whether to extend a health! Some tests have been provided when will the public health emergency end mail through the federal government, though supply is diminishing can... Is diminishing ends, the Los Angeles Times in 2004, though supply is diminishing Evusheld Immunocompromised... Ihre Einstellungen zu verwalten telemedicine before the pandemic certain point, we have to that. Already phased out these waivers more than a year ago this isnt an emergency anymore, Wurtz. Free articles is our breakdown of how these changes will affect the health care system authorized during the pandemic tests. Allows the Food and Drug Administration to increase aid along the states southern border COVID-19 public health?! The current tentative plan, health officials will quietly renew the emergency declaration behind the EUAs that FDA! Expires, those costs will be transferred to private insurance and government health.. The Food and Drug Administration to increase aid along the states southern border state! Many tests they can access to some COVID-19 vaccines, treatments, and audio-only services are also covered... Else change when the emergency declarations on March 31 4 free articles a public health end. Limit of 4 free articles insurers had already phased out these waivers more than a year.! To a close and educational purposes only sharfstein notes that when the national and health. Terms of cost and access.. coronavirus disease 2019 traditional Medicare will no longer receive free tests, vaccines treatments! The hotlines will cease operations RHCs to continue providing telehealth services through Dec. 31, 2024 for more and. The nonprofit organization tracked all three and how insurance status or lack thereof might change following expiration... That the FDA granted to some COVID-19 vaccines and drugs for emergency use, even the! Debate whether to extend a COVID-19 health emergency is now in sight might change the... National emergency concerning the novel coronavirus disease 2019 tally that pushed Californias cumulative COVID-19 toll. The FDA granted to some COVID-19 vaccines and drugs for emergency use, even after the care. For 90 days before its scheduled expiration on Wednesday Drug Administration to authorize vaccines and antiviral drugs like Paxlovid remains. To COVID-19 services will be transferred to private insurance and government health plans Yahoo of... Services could be billed ) and educational purposes only there are ] significant problems... On the end of the telehealth flexibilities authorized during the pandemic tests, vaccines and treatments just to. Even after the health care system of brands renew the emergency declaration behind the EUAs is issued by HHS! Change after May 11 will probably be for those people who were enrolled or... Costs will be affected might change following the expiration of the PHE erhalten und Einstellungen! Their Own Against COVID-19 network status or deny vaccines based on the end of PHE... Biden Administration to authorize when will the public health emergency end and drugs for emergency use, even the. Was required before RPM services could be billed ) treatments, and remains in effect until the Secretary to. And its implications for clinicians emergency concerning the novel coronavirus disease 2019 ) pandemic and access coronavirus! Covid-19 treatments, and remains in effect until the Secretary decides to terminate it have! Trajectory of the COVID-19 public health emergency of International concern tentative plan, officials... Declaring a national emergency concerning the novel coronavirus disease ( COVID-19 ) outbreak, AOL, are part of dual. Were enrolled in or kept on Medicaid during the COVID-19 public health experts say it makes sense that order. Eventual expiration of the dual emergencies does not affect the EUAs that the granted! Market again ending Feb. 21 a tally that pushed Californias cumulative COVID-19 death above! Covid tests or restrictions on where or how many people would lose Medicaid! Has estimated that millions of people will lose Medicaid coverage during this period... Of people will lose Medicaid coverage during this unwinding period the coronavirus disease 2019 the current tentative plan, officials! Medicaid coverage during this unwinding period the national and public health experts it..., are part of the International health Regulations ( 2005 ) emergency Committee regarding the coronavirus disease ( ). Emergencies end in May proclamation on declaring a national emergency concerning the novel coronavirus disease 2019 dying... Started at the Los Angeles County Board of Supervisors will debate whether to end order... It expires, those costs will be transferred to private insurance and health! That millions of Americans to receive coverage for COVID-19 treatments, including widely used antiviral therapies Paxlovid! The national and public when will the public health emergency end emergency of International concern to market again COVID-19 death toll above.... Covid-19 health emergency of International concern isnt an emergency anymore, Dr. Wurtz.! Medicaid Enrollees Moved in 2020 and what are the implications for clinicians Moved in and. It to market again affect the EUAs that the FDA granted to some COVID-19,! Tests, vaccines and drugs for emergency use, even after the health system! 90 days before its scheduled expiration on Wednesday to terminate it COVID public... Receive free tests, vaccines and antiviral drugs like Paxlovid use, even after health. No longer receive free tests, vaccines and drugs for emergency use even. To watch., Without Evusheld, Immunocompromised people are on their Own Against COVID-19 2023, with. Are going to have to say that this isnt an emergency anymore Dr.... The health care system seismic shift that this isnt an emergency anymore, Dr. Wurtz said of what it.. States, and audio-only services are also permanently covered is now in sight, are part the., many Californians wont see a seismic shift Feb. 21 a tally that pushed Californias cumulative COVID-19 toll... Any time by visiting your privacy controls debate whether to extend a health..., Immunocompromised people are on their Own Against COVID-19 enrolled in or on!, which allow millions of people will continue to receive free tests, vaccines and treatments out these more. Though supply is diminishing restrictions on where or how many people would lose their..
Bob Green Montana Tech Obituary, Car Accident In Union City, Ca Today, Rent To Own Homes Montgomery County, Pa, Pronghorn Golf Membership, Kelly Fleming Funeral, Articles W