Update on Federal Mandates to Cover COVID-19 Testing Services: New Guidance for States, Plans, and Insurers

In March, as COVID-19 cases were surging, Congress enacted two bills to help ensure that consumers could access free diagnostic tests. The congressional mandate (included in the Families First Coronavirus Relief Act (FFCRA) and amended by the Coronavirus Aid, Relief, and Economic Security (CARES) Act), directs employer group plans and insurers (including self-funded and grandfathered plans) to cover and waive enrollee cost-sharing for diagnostic COVID-19 tests and any services required to determine the need for such a test. Almost immediately after enactment of these bills, there were questions about the scope of the new mandate and potential gaps that could expose consumers to unexpected out-of-pocket costs.

The federal agencies responsible for regulating insurers and employer health plans – the Departments of Health & Human Services, Labor, and Treasury (collectively, the “tri-agencies”) – published guidance on April 11 in attempt to clarify some of the law’s requirements. However, as calls have increased for more widespread and frequent testing, particularly of at-risk populations such as health care workers, residents and staff of long-term care facilities, and people potentially exposed at protests or rallies, insurers have questioned their responsibility to cover all testing in all circumstances. State regulators have had to step in, with some requiring insurers to cover, for example, specified workplace-related testing, while others have agreed with insurers that such testing would not be “medically necessary.” On June 23, the tri-agencies published new guidance that attempts to answer implementation questions from states, plans, and insurers. In her latest post for the State Health & Value Strategies project, Sabrina Corlette reviews what this latest guidance means for states and their efforts to protect workers and residents. You can read her analysis here.

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