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Departments issue FAQs on implementation of FFCRA and CARES Act

Health and Benefits
COVID 19 Coronavirus

By Maureen Gammon and Anu Gogna | April 22, 2020

The FAQs also clarify other COVID-19-related health coverage issues, including excepted benefits, telehealth and other remote care services.

The Departments of Labor, Health and Human Services, and Treasury have issued FAQ guidance on implementation of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The FAQs also clarify other COVID-19-related health coverage issues, including excepted benefits, telehealth and other remote care services. The guidance is effective immediately.

The FFCRA, as amended by the CARES Act, requires group health plans to provide first-dollar coverage for COVID-19 testing and related medical office, urgent care and emergency room costs, lasting through the public health emergency period.1 The departments note that their implementation approach focuses on assisting (rather than penalizing) group health plans, health insurance issuers and others that are working in good faith to comply with the FFCRA and CARES Act.

FFCRA and CARES Act

The FAQs include the following clarifications on the COVID-19 testing mandate provisions in the FFCRA and CARES Act:

  • Plans subject to the testing mandate. The COVID-19 testing mandate applies to group health plans and health insurance issuers offering group or individual health insurance coverage (including grandfathered health plans). This includes ERISA plans, non-federal governmental plans (such as plans sponsored by states and local governments), and church plans. Not included are short-term limited-duration insurance, excepted benefits and retiree-only plans.
  • Effective date of testing mandate. Plans will be required to provide benefits for certain items and services related to diagnostic testing for COVID-19 beginning on or after March 18, 2020, and during the applicable emergency period.
  • Items and services required to be covered. Plans are required to cover 1) in vitro diagnostic tests (including serological tests); and 2) items and services furnished to an individual during a health care provider office visit (including in-person and telehealth visits), urgent care center visits and emergency room visits that result in an order for or administration of an in vitro diagnostic test.
    In addition, any items and services furnished during visits (including in-person and telehealth) that result in an order for or administration of a COVID-19 diagnostic test must be covered to the extent they relate to the furnishing or administration of the test, or help a health care provider determine the need for such a test. For example, if a provider determines that a blood test and influenza test are necessary to assess the need for COVID-19 diagnostic testing, and the visit results in an order for or administration of COVID-19 diagnostic testing, the blood and influenza tests must be covered.
  • Cost sharing, prior authorization and medical management requirements. The items and services discussed above must be provided without cost sharing (including deductibles, copayments and coinsurance), prior authorization or other medical management requirements.
  • COVID-19 testing at out-of-network providers. Plans are required to cover the items and services described above at out-of-network providers. If the plan has a negotiated rate with such provider in effect before the public health emergency was declared, then the negotiated rate will apply for the duration of the declared emergency. If the plan does not have a negotiated rate with the out-of-network provider, the plan must reimburse the provider equal to the cash price for the service as listed by the provider on a public Internet website (or the plan can negotiate a lower rate than the cash price).
  • SBC material modification notice relief. Generally, if a plan sponsor makes a material modification to the plan terms or coverage that is not included in the most recent Summary of Benefits and Coverage (SBC) (and that occurs outside of a renewal or reissuance of coverage), the plan must notify enrollees within 60 days prior to the date on which the modification takes effect. The FAQs clarify that the departments will not take any enforcement action against a plan that makes a modification to provide greater coverage related to the diagnosis and/or treatment of COVID-19 but fails to satisfy the SBC advance notice requirement; however, the departments note that plans must provide notice as soon as practicable. When such changes extend beyond the emergency period, all other applicable requirements must be met to update plan documents or terms of coverage. The same relief applies to plans that add benefits, or reduce or eliminate cost sharing, for telehealth and other remote care services.

Excepted benefits

The FAQs clarify that an employer may offer benefits for diagnosis and testing for COVID-19 at an onsite clinic or through an employee assistance program (EAP) that meets the requirements to be considered an excepted benefit while a public health or national emergency declaration is under effect.

Telehealth and other remote care services

The FAQs confirm that an individual who has other health plan coverage in addition to a health savings account (HSA)-qualifying high-deductible health plan (HDHP) could receive coverage for telehealth and other remote care services outside of the HDHP, and before satisfying the HDHP deductible, and still be eligible to contribute to his or her HSA.

Footnote

1 See “Mandatory coverage of COVID-19 testing and small employer paid leave signed into law,” Insider, March 2020; and “The CARES Act: Health and benefit implications for plan sponsors,Insider, April 2020.

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Senior Regulatory Advisor, Health and Benefits

Senior Regulatory Advisor, Health and Benefits

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