January 10, 2022 federal guidance implementing the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, (the “Federal Guidance”) requires coverage of FDA approved over-the-counter (“OTC”) COVID-19 tests, with or without an order or individualized clinical assessment by an attending health care provider. Consistent with the federal guidance, this expanded coverage requirement took effect on January 15, 2022 and continues during the federal public health emergency.
The New Jersey Department of Banking & Insurance issued a Bulletin on January 20th notifying all health insurers, HMOs, health service corporations (Horizon) and any other entity issuing health benefit plans in New Jersey of its obligation to make available to covered persons which must be prominently displayed on the carriers’ website. The Bulletin is linked here.
The information displayed must be consistent with the federal guidance and include a “FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION PART 51, FAMILIES FIRST CORONAVIRUS RESPONSE ACT AND CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT IMPLEMENTATION”
The information displayed also must be sufficient so that the covered persons understand where tests can be obtained without payment of any costs. Carriers must also warn covered persons of circumstances where costs could be incurred for OTC COVID-19 tests, including if the test is not obtained through any applicable direct coverage option. Any safe harbor approach taken by a carrier must be consistent with the federal guidance and clearly explained to covered persons.
Further, the Department also recently extended under Executive Order 281 and that P.L. 2021, c. 310 repealed P.L. 2020, c. 3 and P.L. 2020, c. 7 and re-codified the requirement to provide coverage, without the imposition of any cost sharing, prior authorization requirements, or other medical management, for testing for COVID-19, provided that a health care practitioner has issued a medical order for the testing. Finally, the law requires coverage for items and services furnished or provided to an individual during health care provider office visits, including in-person visits and telemedicine and telehealth encounters, urgent care center visits, and emergency department visits, that result in an order for administration of a test for COVID-19. The coverage requirement applies during any portion of the federal state of emergency declared in response to the COVID-19.