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Biden Administration Clarifies COVID-19 Testing Coverage Requirements

For CEOs, CFOs, COOs, revenue cycle & government relations staff

On Feb. 26, the Departments of Health and Human Services, Labor, and Treasury updated guidance related to COVID-19 testing. The clarifications should improve access to no-cost-sharing COVID-19 testing for both the insured and uninsured. However, it stops short of requiring health plan coverage of COVID-19 testing for public health surveillance. 

The updated guidance clarifies that under the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act health plans: 

  • Are prohibited from imposing medical management, including specific medical screening criteria, on coverage of COVID-19 diagnostic testing. Plans and issuers cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests. 
  • Must cover point-of-care tests the same as other COVID-19 tests. 
  • Are required to cover tests provided through state or locality-administered testing sites, “drive-through” sites, and/or a site that does not require appointments.  

However, consistent with previous guidance, health plans are not required to cover testing for public health surveillance or employment purposes.  

The updated guidance, similar to previous documents, clearly states that plans must cover items and services furnished to an individual during health care provider visits (including telehealth visits) that result in an order for or administration of a COVID-19 test. However, coverage is limited to items and services related to  furnishing or administering the product, or to the evaluation of the individual for purposes of determining the need of the individual testing.  

The document also reminds providers of funding available through the HRSA COVID-19 Uninsured Program to reimburse providers for services — including testing — provided to uninsured patients related to COVID-19. Providers are not required to ascertain a patient’s immigration status in order to receive reimbursement from the fund.