Guidance on expanded coverage for diagnostic services for the coronavirus has been issued by the Centers for Medicare and Medicaid.
According to CMS, Americans covered by private health insurance will be able to get coverage of COVID-19 diagnostic testing and some other related services, including antibody testing, at no cost.
“It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” CMS administrator Seema Verma said in a statement. “Today’s action under the leadership of President Trump allows millions of Americans to access the vital health services they need to fight COVID-19, including antibody testing once it becomes widely available.”
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The guidance imposes requirements on insurers to provide “certain items and services related to diagnostic testing” for COVID-19 to insureds “without imposing any cost-sharing requirements (including deductibles, copayments, and coinsurance) or prior authorization or other medical management requirements” for those “items and services … furnished on or after March 18, 2020, and during the applicable emergency period.”
Those “items and services,” according to CMS, include “urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test” as well as antibody testing.
In addition, the guidance states that states are not prevented “from imposing additional standards or 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.”
And while the guidance applies to group health plans (both insured and self-insured) and group and individual health insurance, “private employment-based group health plans (ERISA plans), non-federal governmental plans (such as plans sponsored by states and local governments), and church plans,” it does not apply to short-term, limited-duration insurance, nor does it apply to a plan or coverage in relation to its provision of excepted benefits or to group health plans that don’t cover at least two current employees (such as plans in which only retirees participate).
The inclusion of antibody testing could provide a more accurate means of figuring out how many people have been infected, as well as possibly helping to get more people back to work more quickly, according to the agency.