In the second major piece of legislation responding to the novel coronavirus (COVID-19) pandemic, the President signed the Families First Coronavirus Response Act (“Act”) into law on March 18, 2020.
Division F of the Act contains provisions requiring coverage of testing for COVID-19 and a prohibition against plans imposing any cost sharing on patients, including deductibles, copayments, and coinsurance. Plans are also prohibited from imposing prior authorization requirements or other medical management requirements. For example, a plan could not require a participant to first have a flu test before the plan would pay for a COVID-19 test.
Under the Act, providing benefits for testing without cost sharing is required of nearly all group health plans and health insurance issuers. Both fully insured and self-funded plans are subject to the new mandate, as well as plans that are “grandfathered” under the Affordable Care Act. This part of the Act is effective as of March 18, 2020.
The following items and services are included within the mandate:
- Federally-approved diagnostic products for testing.
- Items and services furnished during the office visits (including telehealth), urgent care visits, and emergency room visits that relate to and result in either an order for or administration of the test.
Many plans and insurers provided coverage of testing for COVID-19 without cost sharing. We recommend employers contact their insurer or third-party administrator to confirm coverage testing will be provided in accordance with the Act’s mandate.
Enforcement authority is shared by Health and Human Services, the Department of Labor, and the Internal Revenue Service. We expect guidance may be delayed as agencies are dealing with rapid developments in the law. One outstanding question is whether plans must provide the mandated benefits without cost sharing only at in-network providers, or whether the coverage mandate applies out-of-network.
Other sections of the Act require certain employers to provide emergency paid family and medical leave and emergency sick leave to employees.
