The Senate will begin reviewing the House-passed Families First Coronavirus Response Act (House Bill) Monday March 16th. If it passes (which seems likely given the President’s support of it), the impact will be major for employers. The leave-related components of the House Bill are highlighted in a separate alert; this alert focuses on the provisions impacting private health plans.
With COVID-19 testing being a main focus of many, the House Bill took the “pledges” of several major insurance providers to provide coronavirus tests at no cost to patients a step farther. The overall message throughout Division F (the Health Plan Division) of the House Bill – make sure that access to testing (and any related office visit) – will be covered without cost to the individual/consumer/beneficiary.
While in-office testing (also referred to as “point of care” testing) is “covered” by these provisions, we note that in-office testing is not the primary vehicle for providing access to testing currently targeted by the Administration. Rather, the “drive thru” model is the current focus (at least according to the Administration’s March 13th press conference). Presumably, drive thru access will also be covered.
The House Bill’s health plan provisions are generally effective for the duration of the public health emergency, as declared by the Secretary of Health and Human Services (HHS). As a reminder, HHS Secretary Alex M. Azar II first declared a public health emergency on January 31, 2020 in response to coronavirus/COVID-19. This status, of course, remains in effect. More on the specifics of the House Bill as it relates to employer plans:
- Private health plans (self-insured and fully insured, including ACA-grandfathered plans) must provide coverage for COVID-19 diagnostic testing, including the cost of a provider, urgent care center and emergency room visits (referred to herein collectively as “office visits”) in order to receive testing with no cost-sharing (including deductibles, copayments, and coinsurance) and no pre-authorization or other medical management requirements imposed.
- Items and services furnished to an individual during an office visit that result in an order for or administration of a test are also covered by the no cost-sharing and no pre-authorization/medical management requirements. Note, however, that this covered office visit applies only to the extent such items/services relate to the evaluation and/or testing of the individual. Broader coverage for treatment (beyond determining if a test is needed and to administer it) is apparently not covered by this federal legislation.
- Additional guidance (likely in the form of sub-regulatory guidance – probably FAQs) are expected to be issued by the three implicated agencies Health and Human Services, Labor, and Treasury) on the scope of this provision and how health plans are to implement it.
Overall, when it comes to private employer health plans, best practice remains the same. Coordinate closely with your plan’s insurance carrier(s) and/or TPA to ensure that your team understands what will be covered and when. It is important to have accurate, up-to- date information to communicate to employees/participants covered by the company’s medical plan as needed.
Outside the direct scope of employer plans, the House Bill contains additional health plan-related items:
- Expansion of Medicare Coverage. Medicare Part B will purportedly cover beneficiary cost-sharing for provider visits during which a COVID-19 diagnostic test is administered or ordered. Similarly, Medicare Advantage must provide coverage for COVID-19 diagnostic testing, including the associated office visit cost with no cost sharing.
- This provision is unlikely to impact private plans given Medicare is typically the secondary payer.
- The House Bill makes a “clarification” to the Medicare telehealth provision of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123) (the $8.3B funding bill signed into law on March 6, 2020) to ensure that new Medicare beneficiaries are able to access telehealth services under the emergency authority granted to the Secretary of HHS.
- Medicaid and CHIP. Medicaid and CHIP coverage is also covered by the House Bill. Like Medicare, Medicaid programs must provide coverage for COVID-19 diagnostic testing, including the associated office visit cost with no cost sharing. States also have the option to extend Medicaid eligibility to uninsured populations for the purposes of COVID-19 diagnostic testing. To incentivize State spending, state expenditures for medical and administrative costs associated with this Medicaid expansion will be matched by the federal government at 100 percent. An increase in federal funding of Medicaid during Fiscal Years 2020 and 2021 is also provided for in this House Bill.
- TRICARE, Coverage for Veterans, Coverage for Federal Civilians. The same expansion (no cost-sharing on testing and associated office visits) is extended under TRICARE, Coverage for Veterans, Coverage for Federal Civilians as well those covered by health services systems funded by the Indian Health Service or a health service of the Indian Health Service (primarily covering American Indians and Alaskan Natives at tribal care facilities).
- Uninsured Coverage Not Covered by Medicaid. The uninsured are covered by the House Bill (on a federal level to the extent a state does not opt to expand its Medicaid coverage to the uninsured). The National Disaster Medical System and the Secretary of HHS will reimburse the costs of COVID-19 diagnostic testing provided to individuals without insurance (with appropriations for this coverage allowed at up to $1 billion).
- PREP Act – Expansion of Protection for Personal Respiratory Device Companies. The Public Readiness and Emergency Preparedness Act of 2005 (PREP Act) amended the Public Health Service Act (PHSA) to provide liability immunity related to the manufacture, testing, development, distribution, administration and use of medical countermeasures against events, including pandemics. Through the House Bill, certain personal respiratory protective devices are to be treated as covered countermeasures under the PREP Act Declaration for the purposes of emergency use during the COVID-19 outbreak through October 1, 2024.