On June 23, 2020, the Departments of Labor, Health and Human Services, and Treasury jointly issued a supplemental set of frequently asked questions (FAQs) interpreting the COVID-19 testing coverage provisions under the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).
The FAQs build upon a set of FAQs issued in April. Like the prior guidance, these FAQs focus on Section 6001 of the FFCRA and Section 3201 of the CARES Act, both of which require group health plans and health insurance issuers to cover certain benefits and services related to COVID-19 testing and diagnosis without imposing cost-sharing, prior authorization, or other medical management requirements.
Interestingly, the FAQs address the extent to which testing must be covered under return-to-work orders and guidance. For example, the FAQs note that:
- At-home testing must be covered in accordance with the FFCRA (when the test is ordered by an “attending health care provider” who has determined that the test is “medically appropriate”);
- Testing for surveillance purposes/to screen for general workplace health and safety does not need to be covered, as it is beyond the scope of the FFCRA; and
- There is no limit on the number of diagnostic COVID-19 tests that must be covered for an individual, provided the tests are diagnostic and medically appropriate for the individual.
Beyond the return-to-work context, the FAQs further clarify several provisions addressed in the prior FAQs. Specifically, they explain:
- That self-insured group health plans are subject to the FFCRA’s provisions;
- The types of tests (e.g., in vitro diagnostic tests, at-home testing) that a plan or issuer must cover;
- The reimbursement requirements under the CARES Act, how they interact with federal law and state balance billing laws, etc.;
- The notification requirements if plans and issuers choose to revoke changes to coverage made during the national emergency (i.e., cost-free testing) once the national emergency concludes;
- How employers can offer standalone telehealth and other remote care services to employees during the pandemic;
- Implications for grandfathered health plans and compliance with the Mental Health Parity and Addiction Equity Act of 2008;
- The operation of “health-contingent” wellness programs; and
- The notice requirements for employers offering individual coverage health reimbursement arrangements.
For more information, the FAQs can be found here.