Insurers are not required to cover COVID-19 tests that employers may mandate as they bring employees back to work, according to a guidance released Tuesday by the Trump administration.
Insurers had been waiting for clarity from the administration on whether they would be on the hook for potentially repeated COVID-19 screening tests as states relax social distancing restrictions and employees return to work. The Families First Coronavirus Response Act required insurers to cover COVID-19 tests without patient cost-sharing, but Tuesday's guidance clarified that the law only applies to tests that are deemed "medically appropriate" by a healthcare provider.
"Testing conducted to screen for general workplace health and safety (such as employee "return to work" programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition is beyond the scope of section 6001 of the [Families First Coronavirus Response Act]," the guidance from HHS, the Department of Labor, and Department of the Treasury states.
Nursing homes will be among those most impacted by the new testing coverage guidance. Some states require the facilities to test employees regularly and CMS recommends weekly testing.
The American Health Care Association/National Center for Assisted Living said they hope insurers will voluntarily decide to foot the bill for the tests anyway.
"Repeated, ongoing testing is the only way we are going to beat this virus. We hope that insurers will understand this and cover the costs," AHCA/NCAL said in a statement.
AHCA/NCAL estimated that testing all employees of nursing homes and assisted living facilities once would cost $672 million.
America's Health Insurance Plans commissioned a study that found diagnostic testing could cost the U.S. between $6 billion and $25 billion annually, and antibody testing could cost $5 billion to $19 billion. AHIP did not immediately respond to a request for comment on the new guidance.
As healthcare utilization plummeted, the nation's largest health insurers came out of the first quarter virtually unscathed financially from pandemic.
James Gelfand, the senior vice president of health policy at The ERISA Industry Committee, said the new guidance is consistent in finding that the testing coverage mandate for insurers does not apply to tests administered solely for public health applications.
"We know testing is important for reopening the economy, and hope Congress and the administration can help ensure adequate resources are available to support the testing needed," Gelfand said in a statement.
The National Association of Insurance Commissioners in May asked HHS to clarify guidance on coverage requirements for tests used for surveillance purposes.
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June 24, 2020 at 08:05AM
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Trump administration says insurers off the hook for back-to-work COVID-19 tests - ModernHealthcare.com
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