- Posted by Jessica Waltman
- On April 23, 2020
The Departments of HHS, Labor, and Treasury issued FAQs about the health coverage provisions in the FFRCA and the CARES Act on April 11, 2020.
Some key points in the FAQs include:
- States may impose stricter COVID-19 coverage standards/requirements on health insurance issuers with respect to the diagnosis or treatment of COVID-19, to the extent those standards or requirements do not prevent the application of a federal requirement. The federal rules are a floor, not a ceiling.
- The only plans not affected by the coverage requirements are STLDI, retiree-only plans, and excepted benefits. Excepted benefit EAPs and worksite clinics that refer to or provide testing do not jeopardize their excepted benefit status by doing so.
- The coverage mandate only applies during the public health emergency. Right now that is between March 18-June 16, 2020, but it may be extended.
- Issuers have to cover COVID-19 diagnostic tests and services that result in a test order, BUT only to the extent the items and services relate to the furnishing or administration of the product or to the evaluation of the individual for purposes of determining the need of the individual for such product. Examples of this noted include flu tests, respiratory tests and other services that tells a provider if the person needs a COVID-19 test or if they actually have something else.
- If the issuer/provider have a negotiated rate for lab tests or other services covered by this mandate prior to March 18, 2020 (the start date of the public health emergency), that rate applies for provider payment. If there is no prior negotiated rate, the issuer must either pay the provider’s online listed cash price for COVID-19 testing, or negotiate a lower reimbursement rate. Every provider must post an online cash price, or face a $300/day penalty.
- The CARES Act specification that issuers may allow qualified high deductible health plans (HDHPs) to cover telehealth services and other remote care services without a deductible or with a deductible below the minimum annual deductible in plan years that start on or before December 31, 2021, applies to all telehealth and other remote health care services, not just those related to coronavirus.
- Regarding the COVID-19 testing coverage mandate, and the HDHP telehealth provisions, the regulations provide enforcement relief for the summary of benefits and coverage 60 day prior notice requirement, relative to material modifications of a plan that would change the SBC. Plans and issuers must provide notice of the changes as soon as reasonably practicable.
- HHS also will not take enforcement action against any health insurance issuer that changes the benefits or cost-sharing structure of its plans mid-year to provide increased coverage for services related to the diagnosis and/or treatment of COVID-19. HHS encourages states to take a similar approach, and will not consider a state to have failed to substantially enforce section 2703 of the PHS Act if it takes such an approach.
- These non-enforcement policies apply with respect to changes made during the public health emergency declaration (currently slated to run through June 16, 2020) or when a national emergency declaration under the National Emergencies Act related to COVID-19 is in effect. If a plan or issuer maintains related changes beyond the emergency period, plans and issuers must comply with all other applicable requirements to update plan documents or terms of coverage. Notably, this SBC/coverage terms/plan document relief only applies to the coverage mandate and the telehealth provisions, according to the FAQs, not to any other plan modifications that may occur due to COVID-19. Also, plans may not reduce, limit, eliminate or change other benefits or cost-sharing in order to adjust for changes related to COVID-19 testing coverage or telehealth coverage deductible requirements for HDHPs. If they do, they will be subject to enforcement action.