Regulatory Actions Impacting Health Insurers and Managed Care Companies in Response to COVID-19

Faegre Drinker Biddle & Reath LLP
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Faegre Drinker Biddle & Reath LLP

As health insurers and managed care companies work to serve their patient communities during the COVID-19 pandemic, they must also track and adapt to a multitude of new state and federal COVID-19-related regulatory actions impacting their operations. To help organizations stay on top of these regulatory changes, we’ve summarized major regulatory actions in each state and assembled useful resources, guidance and notifications released by state regulators. We’ve also provided an overview of federal legislative activity impacting insurers and managed care companies.

State Actions on Coverage Issues: Visual Overview

The chart below highlights each state’s actions related to high-impact coverage issues and services. The categories below encompass the following:

  • Access to Treatment/Benefit Coverage: Cost-Sharing Waivers, Prior Authorizations, Telehealth Benefits, Vaccine Coverage, Pharmacy Benefits.
  • Policy Terminations: Grace Periods, Premium Waivers, Cancellations.
  • Special Enrollment Periods: Health Care Enrollment Extensions, Additional Health Care Options.
  • Preparedness Plans/Data Calls: Call to Action, Examine Network Adequacy.
  • Licensing/Filing Relief: Prelicensing and/or Licensing Extensions, Notary Waivers.

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  Access to Treatment/Benefit Coverage Policy Terminations Special Enrollment Periods Preparedness Plans/Data Calls Licensing Filing Relief
Colorado          
Connecticut          
Delaware          
District of Columbia          
Florida          
Georgia          
Hawaii          
Idaho          
Illinois          
Indiana          
Iowa          
Kansas          
Kentucky          
Louisiana          
Maine          
Maryland          
Massachusetts          
Michigan          
Minnesota          
Mississippi          
Missouri          
Montana          
Nebraska          
Nevada          
New Hampsire          
New Jersey          
New Mexico          
New York          
North Carolina          
North Dakota          
Ohio          
Oklahoma          
Oregon          
Pennsylvania          
Rhode Island          
South Carolina          
South Dakota          
Tennessee          
Texas          
Utah          
Vermont          
Virginia          
Washington          
West Virginia          
Wisconsin          
Wyoming          
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COVID-19 Regulatory Actions and Resources by State

Alabama: Requesting cost-sharing waivers for COVID-19 testing and an in-network provider office, urgent care or emergency room visit when testing. When a vaccine becomes available, health carriers should immediately cover the immunization at no cost-sharing for covered members. Health carriers are asked to verify their provider networks are adequate to handle a potential increase in the need for health care services. For more information relating to preparedness plans, cost-sharing, telehealth, network adequacy, utilization review, access to prescriptions, or certificates of completion extension related to licensing, premium payments or policy cancellations, view the resources below:

Alaska: Mandatory cost-sharing waivers for laboratory diagnostic testing for respiratory syncytial virus (RSV), influenza, and COVID-19 and requested cost-sharing waivers for in- and out-of-network office visits, emergency room and urgent care visits with the testing. Health Insurers are asked to: (a) review and ensure their telehealth programs are robust and will be able to meet any increased demand, (b) submit a travel plan or protocol for maintaining critical infrastructure to akcovidplans@ak-prepared.com, and (c) permit employers to continue covering employees under group policies even if the employee would otherwise become ineligible due to a decrease in hours worked per week.

Arizona: Insurers required to: (a) cover COVID-19 diagnostic testing from all qualified laboratories without regard to whether the laboratory is in-network, (b) waive all cost-sharing requirements for consumers related to COVID-19 diagnostic testing, and (c) cover telemedicine visits at a lower cost-sharing point for consumers than the same in-office service. An in-person examination of a patient is not required to issue a prescription. State agencies shall defer requirements to renew licenses that have an expiration date between March 1, 2020 and September 1, 2020 by six months from the expiration date, unless those requirements can be completed online. The Arizona Department of Economic Security shall allow individuals to apply for and be approved for unemployment insurance subject to a few requirements.

Arkansas: Insurers must access and review their preparedness plans and plans for continuity of operations to manage the risk of disruption. Carriers must provide a 45-day moratorium on the cancellation/non-renewal of health insurance policies for the non-payment of premiums.

California: Mandatory waiver of cost-sharing for all medically necessary screening and testing for COVID-19, including hospital (including emergency department), urgent care visits and provider office visits. 60-day grace period for payment of insurance premiums. Insurers required to file action plans for how they will ensure continued coverage of medically necessary services during the emergency.

Colorado: Mandatory waiver of cost-sharing for testing and in-network office visits, urgent care or emergency room visits when seeking testing. The waiver applies to out-of-network visits if the in-network provider cannot perform testing. To monitor the impact of COVID-19 on the small and large group health insurance market in Colorado, Carriers are directed to generate monthly reports to the amount of grace periods and waivers. The report request may be found here. Carriers are asked to conduct an outreach and education campaign to remind individuals of their telehealth overage options. Additionally, Carriers are directed to provide telehealth services to cover COVID-19 related in-network telehealth services at no cost.

Connecticut: Health Insurers are encouraged to: (a) waive any cost-sharing related to COVID-19 laboratory tests, (b) waive any cost-sharing related to an in-network provider office visit, urgent care visit, or emergency room visit related to COVID-19 testing, (c) offer and waive cost-sharing for medical advice and treatment of COVID-19 via telehealth services, and (d) permit enrollees, certificate holders and insureds to obtain testing and treatment for COVID-19 out-of-network and provide coverage for such testing and treatment the same as on an in-network basis. The Department requests that health insurers and health care centers provide information on the steps they are taking in response to COVID-19. The Connecticut Insurance Department is only accepting NAIC UCAA electronic applications at this time. From now until June 15, 2020, the current biographical notarization requirements for insurance company licensure in Connecticut, and paper filing requirements of original signatures by domestic insurers instead using electronic delivery and electronic signatures shall be suspended for any insurer that is unable to meet the current requirements due to circumstances related to the current COVID-19 situation, subject to a few requirements. There is a 60-day grace period for insurance premium payments.

Delaware: Insurers are required to waive cost-sharing for testing and in-person and telemedicine visits. Carriers are asked to verify that their provider networks are adequate to handle a potential increase in the need for health care services. The suspension, cancellation and nonrenewal of an insurance policy for nonpayment is prohibited. Covered policyholders are granted an extension of time for the payment of premium due under covered insurance policies during the pendency of the declared state of emergency without penalty or interest. Upon the termination of the COVID-19 State of Emergency, any premium due by a covered policyholder will remain due under a covered insurance policy. Notary requirements may be fulfilled by utilizing audio-visual technology. All businesses are required to do the following no later than May 1, 2020 at 8:00 a.m.: provide employees with a face covering to wear while working in areas open to the general public and areas in which coming within 6 feet of other staff are likely.

District of Columbia: Emergency order requiring cost-sharing waivers for treatment of COVID-19 including for diagnosis, testing, and treatment for COVID-19 for out-of-network providers if there is an unreasonable delay for in-network providers and a future immunization. Out-of-network providers are requested to accept in-network reimbursement. Order requires telehealth cost-sharing to be no more than for in-network in-person services and early prescription refills. Indicates insurers are voluntarily waiving cost-sharing for testing. Carriers shall give prompt notice to enrollees, providers, and the public of the measures they are taking to respond to the COVID-19 threat.

Florida: Requiring early prescription refills during state emergency period. Insurers are directed to review and update their Business Continuity Plans and/or Continuity of Operation Plans immediately. If activated, the company must notify OIR within the same day. Insurers are encouraged to be flexible with premium payments in order to avoid a lapse in coverage.

Georgia: Encouraging insurers to consider options to reduce potential barriers of cost-sharing for testing and treatment and requesting insurers to waive cost-sharing for an in-network office, urgent care and emergency room visit when testing. Health Insurers are to refrain from canceling health policies for the cause of non-payment until May 31, 2020. However, the Commissioner encourages health insurers to be accommodating to consumers who find themselves sin financial difficulty. The suspension on all non-federal filing deadlines and waiver of late filing fees will expire on May 31, 2020. Suspension of certain utilization review and notification requirements expired on May 31, 2020. The public health state of emergency shall terminate on June 12, 2020, unless renewed by the Governor.

Hawaii: The Insurance Commissioner encourages insurers to work with their insureds to ensure coverage continues during this time, policies do not lapse, and to consider the following: (a) refrain from cancelling or non-renewing policies due to non-payment during this time of hardship and to grant a grace period for premium payments to be made; (b) work with insureds on a structured payment plan for late premium payments; (c) waive late fees and penalties; and (d) continue working with insureds for a period of 60 days after this health emergency has passed, or as long as reasonably practical. Hawaii’s state of emergency has been extended to July 17, 2020.

Idaho: Notes insurers waiving cost-sharing voluntarily. While companies are still required to make all required electronic filings, the Department may allow additional time to complete filings, subject to extension guidelines. The Department has also shared guidance regarding COVID-19 related rule and code adjustments to workers’ compensation coverage.

  • Idaho Department of Insurance April 22, 2020 Bulletin 20-06 on Complying with Regulatory Requirements during the Public Health Emergency
  • Idaho Department of Insurance April 27, 2020 Bulletin 20-09 on guidance regarding COVID-19 Related Rule and Code Adjustments
  • Idaho Department of Insurance COVID-19 Resource Page
  • Idaho Department of Insurance Producer Licensing FAQ
  • Visit the Idaho Department of Insurance

Illinois: Encourages health insurance issuers to consider options to reduce the barriers of cost-sharing for testing and treatment of COVID-19. The COVID-19 proclamation is set to expire on May 31, 2020. An executive order extended the state’s telemedicine and licensing requirements bulletin to May 31, 2020 or until the statewide State of Disaster Emergency proclamation expires, whichever is earlier.

Indiana: Insurers are to waive cost-sharing amounts for COVID-19. The Department requests all insurance companies and HMOs in Indiana to institute a moratorium on policy cancellations and non-renewals of any insurance policy and allow a 60-day grace period for premium payments. The Department has extended its declaration of a public health emergency until June 4, 2020, unless further renewed.

Iowa: Requests all health insurers and health maintenance organizations to allow a premium payment 60-day grace period for any Iowa individual health benefit plan.

Kansas: Notes insurers are waiving cost-sharing voluntarily. The Department issued Bulletin 2020-1 to inform of the measures taken by the Department in response to COVID-19.

Kentucky: Waiving state requirements related to telehealth to allow use of non-HIPAA compliant technology. Confirmed that the business of insurance is an essential service. Insurers shall not require preauthorization for the transfer of patients via ambulance to other facilities for the purpose of transferring a patient not diagnosed with Covid-19 to make a bed available. Preauthorization and concurrent review for all inpatient services are suspended. Kentucky is in stage two of reopening but the state of emergency is ongoing.

Louisiana: Emergency regulations requiring cost-sharing waivers for screening and testing for COVID-19 including hospital, emergency department, urgent care, provider office visits, lab testing, telehealth, telemedicine, and any immunizations made available. Regulations also address prior authorization and early prescription refills.

Maine: Requires insurers to waive cost-sharing for screening and testing including all associated costs such as processing fees and clinical evaluations. Allows insurers to impose cost-sharing for out-of-network screening services when the enrollee was offered the service in-network without additional delay but chose instead to visit an out-of-network provider or be tested by an out-of-network laboratory. The Maine stay-at-home order has been extended until May 31. The state has issued an order allowing extension for regulatory filing deadlines.

Maryland: Requires carriers to authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of any time restrictions that would otherwise apply, and requests carriers to waive cost-sharing for in-network provider office visits and urgent care center visits that result in testing, and to waive the cost-sharing for an emergency department visit with testing for COVID-19. The Administration encourages all Life & Health Carriers to make reasonable accommodations so that individuals and businesses do not lose coverage due to non-payment of premium during this emergency. Emergency regulations are forthcoming.

Massachusetts: Carriers are to waive cost-sharing for testing and medically necessary treatment, counseling and vaccinations at in-network office, urgent care or emergency rooms, and at out-of-network facilities when access to urgent testing or treatment is unavailable. Carriers are to waive cost for all testing. The state’s health insurance exchange also announced a special enrollment period specifically in response to the outbreak through June 23, 2020. The state has issued a bulletin relaxing certain administrative procedure during the COVID-19 outbreak, including authorization reviews.

Michigan: Several major insurers announced that they would fully cover the cost of medically needed COVID-19 tests for members. Major insurers also announced that they will cover and encourage the use of telemedicine.

Minnesota: The state issued a memo requesting that health insurance carriers waive cost-sharing for testing and provider visits to be tested, and strongly encouraging carriers to limit or eliminate cost sharing for all forms of treatment for COVID-19 for in-network providers. The memo also advises carriers to take any necessary steps to expand the availability of telemedicine services and eliminate any barriers to its use. Finally, it requests one-time early refill of prescription medication.

Mississippi: The Mississippi Insurance Department has placed a 60 day ban on the cancellation or non-renewal of policies for the non-payment of premiums. Insurers have been directed to adopt procedures that will encourage policyholders to use telemedicine. Consumers with fully-insured individual and group health plans will not be charged co-payments, co-insurance, or deductibles related to COVID-19 laboratory testing the major carriers in the state will waive cost-sharing for medically necessary testing. Mississippi has extended the bulletin regarding the use of telemedicine during the COVID-19 crisis.

Missouri: Health carriers are strongly encouraged to broaden access to telemedicine, waive any cost-sharing for testing, including in-network provider office visits, urgent care center visits and emergency room visits when testing, to provide a grace period for non-payment, to make exceptions to provide access to out-of-network providers and to expand access to prescription drugs. Missouri has extended the bulletin providing grace periods for nonpayment.

Montana: Insurers are encouraged to be flexible with payments, due dates, grace periods, late fees and cancelations. Four major providers are voluntarily expanding their coverage of telehealth services. Four major carriers are waiving customer costs for COVID-19 testing.

Nebraska: Insurance claims for telehealth will not be denied solely on the basis of lack of a signed written statement. Notes insurers are waiving cost-sharing voluntarily.

Nevada: Insurers shall not impose out of pocket cost for COVID-19 testing nor impose an out of pocket cost to a provider when the purpose of a visit is for a COVID-19 test. Insurers are also required to issue guidance to inform its insureds and network providers about options for telehealth and preventative measures related to COVID-19. Finally, insurers shall provide coverage for off-formulary prescription drugs if necessary, to treat the insured. Nevada announced a limited-time Exceptional Circumstance Special Enrollment Period for some Nevadans who missed the Open Enrollment Period. The Nevada Division of Insurance encourages all Health insurance carriers to consider certain relief for Nevadans affected by COVID-19 by permitting employers to continue providing coverage to employees regardless of “actively at work” requirements.

New Hampshire: Insurers must provide coverage without consideration of any deductible or cost-sharing of the initial health care provider visit and of FDA authorized COVID-19 testing who meet CDC criteria. Insurers must cover out of network testing any prior authorization requirements that typically apply to cover diagnostic tests are suspended with regard to COVID-19 tests. Elective medical procedures resumed on May 4 and the stay at home order ended on that same day.

New Jersey: Insurers must waive cost-sharing for medically necessary COVID-19 testing. Carriers must provide access to out-of-network services where appropriate. Carriers should not use preauthorization requirements as a barrier to access necessary treatment for COVID-19.

New Mexico: Insurers shall treat telemedicine visits and in person visits equally. For services related to COVID-19, there must be no prior authorization requirements or cost-sharing obligations. Emergency rules issued requiring cost-sharing waivers for testing and services related to COVID-19 and order requiring enrollee notification regarding COVID-19-related benefits. The state issued a bulletin calling on insurers to avoid surprise medical billing as they are required to cover COVID-19 testing and treatment.

New York: Insurers must waive any cost sharing for in-network COVID-19 tests. Insurers are obligated to cover services delivered via telehealth as they would for other services. Insurers must extend the period for payment of premiums and provide flexibility on policy cancellations. Insurers must cover COVID-19 infection and antibody tests administered by pharmacists without cost-sharing. Insurance companies are required to waive out of pocket costs for in network mental health services for front line workers.

North Carolina: Insurers must waive pre authorization requirements for COVID-19 testing and covered services and provide testing at no cost to consumers. Insurance companies must give their customers affected by COVID-19 the option to defer premium and debt payments. Commissioner of Insurance requests that insurers relax due dates, extend grace periods, waive late fees and consider cancellation or non-renewal of policies only after exhausting other attempts to work with customers. Extra prescriptions are authorized during the state of emergency. Insurers should waiver prior authorization for COVID-19 diagnostic tests and covered services and provide those at no cost to the insured.

North Dakota: Insurers have been asked to remove cost-sharing barriers for testing and treatment and to prepare for additional demand on telehealth and other medically necessary services. Health insurers must relax the guidelines under HIPPA and must start or continue to provide covered services via telehealth. Carriers must cover PCR and antigen tests designed to detect the presence of COVID-19 when a patient’s symptoms indicate the medical need to conduct a test. In addition, the Insurance Department expects carriers to cover antibody tests only when such tests are medically necessary in order to support diagnosis or treatment for COVID-19 or for treatment of another disease when information about COVID- 19 antibodies may impact the future outcome of that treatment for an individual.

Ohio: Testing and treatment related to COVID-19 must be covered without preauthorization and must be covered at the same cost as if provided in-network.

Insurers must permit employers to continue covering employees under group policies even if the employee would otherwise be ineligible due to a decrease in hours. All insurers are to give their insured the option of deferring payments. Employees who lose coverage are eligible for a special enrollment period to enroll in new coverage. Issuers that cover prescription drugs must provide access to a standard and expedited formulary exceptions process. All insurers issuing long term care policies must provide their insureds with a 60-day grace period to pay premiums or submit information. These orders are set to expire upon the expiration of the state of emergency declared by Governor DeWine on March 9.

Oklahoma: Insurers shall not cancel the coverage of any person who has be diagnosed with COVID-19 and is unable to return to work. Requires carriers to waive cost-sharing for testing and an in-person provider office or urgent care visit when testing and for telehealth services as well as pay the provider the telehealth cost-sharing payment. These requirements are in effect “until the emergency is no longer in effect.”

Oregon: Health plans shall cover telehealth services delivered by in-network providers to replace in-person visits whenever possible and medically or clinically appropriate. Insurers shall ensure that cost-sharing requirements for services delivered via telehealth are not greater than if the service was delivered through in-person settings.

On March 25, 2020, an order was issued requiring insurers to provide extended grace periods for payment, suspend all cancellations and non-renewals for active insurance policies, and extend all deadlines for reporting claims. On May 5, 2020 a new order was entered terminating the March 25th order for health insurers offering coverage other than accidental death and dismemberment, disability, and long term care insurance policies. For all other insurance companies and all other lines of insurance, the March 25 order continues in force through May 23, 2020.

The May 5th order requires all health insurers extend deadlines for insureds to report claims, requiring health insurers to give policyholders a minimum grace period of 60 days to pay premiums, and suspending all involuntary cancellations and non-renewals. This order will be in force through June 3, 2020.

On May 5, 2020, an Order was issued replacing the March 25th Order for health insurers offering coverage other than accidental death and dismemberment, disability, and long term care insurance policies. The order requires that insurers extend all deadlines for insured s to report claims and take all practicable steps to provide opportunities for insureds to report claims or provide required communications. Health insurers issuing health insurance policies in Oregon must give policyholder a minimum grace period of 60 days. Health insurers must suspend all involuntary cancellations and nonrenewals, except for policies that have completed the extended grace period. The order takes effect on May 5, 2020 and will be in force through June 3, 2020.

Pennsylvania: All major Health Insurers are covering COVID-19 testing and associated treatment and have committed to waive any cost sharing for the testing. The Department expects medically prescribed diagnostic testing for COVID-19 to be covered without the use of prior authorization requirements. The Insurance Commissioner has requested that insurers relax due dates for premiums, extend grace periods, waive late fees and penalties and consider cancellation only after exhausting other efforts to work with policyholders to continue coverage.

Rhode Island: The Health Insurance Commissioner issued an order requiring carriers to permit all in-network providers to deliver medically necessary telemedicine services. This order is in place until Executive Order 20-06 expires (May 8, 2020).

Insurers must cover COVID-19 testing and screening without prior authorization and without patient cost-sharing. Health insurers shall ensure coverage for advance prescription refills and medical supplies to enable enrollees to maintain at least a 30-day supply during this outbreak. These orders are in effect until the state of emergency in Rhode Island is lifted.

South Carolina: The Department of Insurance has posted a bulletin that advises all insurers to provide relief from certain requirements. These include, extension of premium payment deadlines, grace periods before non-renewals or cancellations become effective, waivers of limitations on out-of-network providers, relaxing prescription refill rules, relaxing prescription drug formulary limitations, increasing access to medical care via telehealth, waiver of fees, penalties or other charges relating to an insured’s temporary inability to submit premium payments. The department has also relaxed requirement for license renewals.

South Dakota: The South Dakota Department of Labor and Regulation requires all health carriers to cover COVID-19 testing and any associated office visit, urgent care, or emergency room charge at no cost to insureds. Pre-authorization requirements for COVID-19 testing or treatment must also be waived. The bulletin also discusses telehealth, network adequacy, and urges health carriers to make reasonable accommodations for premium payments and grace periods. All of these requirements apply through June 30, 2020.

Tennessee: The Tennessee Department of Commerce and Insurance issued a bulletin stating that emergency services or COVID testing and treatment services rendered by an out-of-network provider may be reimbursed in the amount the insured’s health care plan would pay for such services if rendered by an in-network health care provider as payment in full. The Department has also issued bulletins requesting carriers to waive cost-sharing for testing and in-network office, urgent care and any emergency room visits associated with testing or any immunization. The department also requested that insurers provide employers and individuals with flexibility regarding premium payments, grace periods, late fees and payment plans.

The Governor urged Tennessee Department of Health and Department of Commerce to continue working with health insurance carriers to identify and remove any burdens to responding to COVID-19 and improve access to treatment options and medically necessary screening and testing. Health insurers are urged to provide coverage for the delivery of medically necessary telemedicine services, irrespective of network status or originating site. Carriers are urged not to impose prior authorization requirements on COVID-19-related treatment delivered by in-network providers via telemedicine.

Texas: Insurers must cover telehealth services the same as they would cover an in-person visit. Health plans must apply parity to payment and documentation requirements to in-person services for services using a telehealth platform and must not deny, limit, or reduce coverage based on the telemedicine platform used by the physician. This order was issued on March 17, 2020 and may not be in effect for more than 120 days, with the possibility for a 60-day extension.

Health insurers must authorize payments to pharmacies for up to a 90-day supply of any prescription drugs for individuals, unless prohibited by law. Allow prescriptions to be filled at out-of-network pharmacies at no additional cost and waive any requirement for a consumer’s signature unless specifically required by law. This order was issued on April 1, 2020 and may not be in effect for more than 120 days, with the possibility for a 60-day extension.

The Texas Department of Insurance published a bulletin encouraging health insurers, HMOs, and utilization review agents to extend prior authorizations for elective procedures authorized before the Governor’s order directing a postponement of those procedures. The Insurance department also encourages insurers to consider extending referrals for specialists, therapy, counseling services, and other medically necessary services that may have been disrupted.

The Texas Department of Insurance issued a bulletin regarding a mandatory data call for information related to COVID-19 injuries reported to select insurance carriers.

Utah: The Insurance Department has issued recommendations urging insurers to expand coverage for COVID-19 including telehealth services and requesting cost-sharing waivers for screening, testing, and an in-person office, urgent care, emergency room, or telehealth visit when testing is being sought. The request also asks that insurers prepare for the outbreak and consider actions such as early prescription drug refills.

Vermont: Insurers are directed to cover any COVID-19 testing performed by the CDC the VDH or a laboratory approve by CDC or VDH, with no co-payment, coinsurance, or deductible requirement. Health insurers must cover provider office or urgent care visits and emergency services visits for COVID-19 diagnosis and treatment. Insurers must also cover medically necessary prescription drugs related to COVID-19 with no copayment. All health insurance plans must process and reimburse appropriate claims for these services retroactively from March 13, 2020. Insurers must make a 30-day supply of medication available to members refiling their prescriptions. Narcotic and specialty medications as well as short term prescriptions will continue to be subject to standard policies. Insurers may not charge different rates for telehealth services. Health insurance plans shall not charge a deductible, co-payment, or coinsurance for telephone triage services. A health insurer shall not refuse, because of lack of credentials, to pay claims submitted by providers credentialed within a health care organization. All insurers have been requested to provide policy holders with reasonable grace periods to pay premiums to avoid cancellation for non-payment. These orders are set to apply throughout the duration of the COVID-19 state of emergency, except for the order on prescription drugs, which is set to expire on May 13, 2020.

Virginia: Visit Virginia’s Corporation Commission’s website which covers the Bureau of Insurance.

Washington: Insurers shall cover COVID-19 testing prior to the application of any deductible and with no cost sharing this applies to any testing for respiratory viruses, allow enrollees to obtain a one-time refill of their covered prescription medications prior to the expiration of the waiting period, suspend prior authorization requirements that apply to COVID-19, ensure that the enrollee obtains the covered service from out-of-network providers at no greater cost. All of these requirements are ordered to remain in effect until June 3, 2020. This applies to all state-regulated health insurance plans and short-term limited duration medical plans.

The Insurance Commissioner also issued an order requiring insurers to allow a grace period for the payment of premiums no less than 60 days. Insurers must provide for equal payment for telehealth and in-person provider visits. That order is set to expire on June 21, 2020, except for the section on additional extension of the grace period for payment of premiums, which will expire on May 23, 2020.

West Virginia: Insurers must assess and review their plans of preparedness and plans for continuity of operations to manage risk of disruption. The insurance commissioner also suspended normal time frames for claim handling and settlement until further notice. Insurers are directed to adjust claims as expeditiously as possible. These requirements remain in force until further notice.

Insurers must not issue a cancellation or nonrenewal notice if the reason for cancellation or nonrenewal is a result of circumstances stemming from the COVID-19 pandemic and the corresponding state of emergency. Insurers should be flexible with respect to alternative payment arrangements for premiums and premium delinquencies. This order is set to remain in effect “until further notice.”

Insurers are prohibited from enforcing contractual terms that prohibit the delivery of prescription medication. Insurers must not issue a cancellation notice or nonrenewal notice pertaining to any insurance policy, plan or contract if the reason for cancellation or nonrenewal is a result of adverse circumstances resulting from the COVID-19. Insurers shall permit insureds to obtain a 90-day supply of any necessary prescriptions upon refill. Further requests include cost-sharing waivers for testing and for an in-network office visit, in-network urgent care and emergency room visit when testing. It is further requested that insurers allow insureds the use of out of network pharmacies at in-network rates.

Health insurers offering group health plans and/or individual health insurance coverage in this state must, effective March 18, 2020, provide benefits for COVID-19 testing and services for nursing home residents and staff, as well as all people who live or work in assisted living residences and persons working in child care centers. This coverage shall be provided without imposing cost-sharing requirements. This emergency order remains in force “until further notice.”

Wisconsin: A new law requires insurers offering a defined network plan or a preferred provider plan to provide coverage for services, treatment or supplies for COVID-19 from non-participating providers when there are access limitations to participating providers due to the public health emergency. The plan may not require the insured to pay an amount greater than the insured would have paid if the services, treatment or supplies were provided by a participating provider. This policy is in force through 60-days following the termination of the declared public health emergency. With respect to limited health service organizations, defined network plans, preferred provider plans, disability insurance policies, and non-federal, government self-insured health plans, the new law requires coverage of testing for COVID-19 without copayment or coinsurance if the plan or policy includes coverage for testing of infectious diseases. Insurers also may not establish rules for eligibility that are based upon a suspected, current, or past diagnosis of COVID-19. The state has issued a bulletin requesting insurers waive cost-sharing for testing and requesting that insurers review telehealth programs to make sure that they can meet increased demand. Health Plan Issuers are requested to expedite prior authorization requests to the extent possible. Health Plan Issuers should not use prior authorization requirements as a barrier to access necessary treatment for COVID-19.

Wyoming: The Wyoming Department of Insurance issued a bulletin encouraging cost-sharing waivers for testing for COVID-19, respiratory syncytial virus, influenza, and respiratory panel test, and for an office, urgent care, or emergency room visit associated with the testing, for both in-network and out-of-network providers. Insurers are additionally asked to provide a preparedness plan to the department. All these requirements are set to be in effect until May 30, 2020.

Federal Legislation

Congress has passed the Families First Coronavirus Response Act and the President signed it into law on March 19, 2020. Among other things, this Act requires health insurance issuers to provide coverage (at no cost-sharing or pre-authorization/medical management requirements) for the testing and administration of FDA-approved COVID-19 tests furnished on or after March 18, 2020 and during the applicable emergency period. The same requirements would apply to related services, including an in-person or telehealth provider visit, urgent care center visit, and emergency room visits that result in an order for COVID-19 testing. The waiving of cost-sharing and related requirements only applies to the services relating to COVID-19 evaluation and testing. The COVID-19 testing mandate does not apply to group health plans that do not cover at least two employees who are current employees. It also does not apply to short-term, limited-duration insurance.

On March 27, 2020, President Trump signed an emergency aid package known as the Coronavirus Aid, Relief, and Economic Securities Act or CARES Act (H.R. 748), which reinforces the goal of making COVID‑19 testing free to Americans. Under the CARES Act, coverage should be provided with no cost-sharing, regardless of the network status of the provider or lab and regardless of whether the testing is done on an emergency basis. The CARES Act instructs health plans to pay a provider’s negotiated rate or, if a health plan does not have a negotiated rate with the provider, pay the provider’s publicly available cash price for testing. The CARES Act also amends laws applicable to high deductible health plans (HDHPs) and Health Saving Account (HSAs) to provide flexibility with respect to telehealth and other remote care services.

The IRS issued guidance providing flexibility to HDHP’s to provide health benefits for testing and treatment of COVID-19 without application of a deductible or cost sharing. Specifically, under this guidance an HDHP will not fail to be a HDHP merely because the health plan provides medical care services and items purchased related to testing for treatment of COVID-19.

The Centers for Medicare and Medicaid Services (CMS) issued guidance regarding payment and grace period flexibility associated with COVID-19. The enforcement of this policy allows issuers to extend payment deadlines and delay the beginning of any applicable grace period. Once a grace period is triggered, the basic requirements applicable to the grace period remain unchanged.

CMS has also encouraged insurers and states to take efforts to increase access to telehealth services, and prescription drugs. And it has provided guidance on the impact of COVID-19 on catastrophic plan coverage and essential health benefits. CMS also encourages issuers to relax otherwise applicable utilization management processes, as permitted by state law. CMS also encourage issuers to work with out-of-network providers to agree upon a rate to ensure that enrollees are not balance billed. The CARES Act generally requires plans and issuers subject section 6001 of the FFCRA to reimburse any provider of COVID-19 diagnostic testing an amount that equals the negotiated rate or, if the plan or issuer does not have a negotiated rate with the provider, the cash price for such service that is listed by the provider on a public website.

The Labor Department has stated that insurers can allow the newly jobless to sign up for the coverage extension, COBRA, at any time for up to 60 days after the state of national emergency has ended.

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Faegre Drinker Biddle & Reath LLP
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