April 16, 2020
In an effort to remove financial barriers for Americans to receive necessary tests and health services related to COVID-19, the Centers for Medicare & Medicaid Services (“CMS”), along with the Departments of Labor and the Treasury, issued guidance on the coverage requirements for private health insurers during the pandemic. The guidance, which focuses on the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) and the Families First Coronavirus Response Act (the “FFCRA”), also encourages the use of telehealth and other remote care services as being vital to combat the COVID-19 public health emergency. Below are some key takeaways for health care providers and facilities and their patients:
- Group health plans and health insurance issuers offering group or individual health insurance coverage are required to cover a broader range of COVID-19 diagnostic items and services without any cost-sharing requirements, prior authorization or medical management requirements. The complete list of items and services for which group health plans and health insurance issuers must now cover is available here.
- Group health plans and health insurance issuers providing coverage for such items and services are instructed to reimburse any provider of COVID-19 diagnostic testing an amount equal to (i) the negotiated rate or (ii) the cash price for the service that is listed by the provider on a public website if the group health plan or health insurance issuer does not have a negotiated rate with the provider. Providers of diagnostic tests for COVID-19 are required to display, on the provider’s public internet website, the cash price of a COVID-19 diagnostic test.
- Group health plans and health insurance issuers must cover COVID-19 related items and services when furnished in both traditional or non-traditional settings, including in-person and telehealth visits, visits to urgent care centers and emergency rooms, COVID-19 drive-through screenings, and testing sites where licensed healthcare providers are administering COVID-19 diagnostic testing.
- Compliance with the above rules must continue for the duration of the COVID-19 public health emergency.
- The entirety of the guidance is available here.
As always, we are available to advise and assist you at every turn. Please do not hesitate to reach out to us with any questions.