Federal rules created in response to two recently passed federal laws require private payers to cover COVID-19 molecular and serology tests, as well as other related tests, such as to detect influenza. But the rules also include a requirement that providers post their cash price for COVID-19 tests on their public websites, or risk fines of up to $300 per day, according to a guidance document.
As part of the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Centers for Medicare & Medicaid Services (CMS) and the Treasury and Labor departments published a question-and-answer document outlining what services are covered and how payers and providers should negotiate prices for these tests. Here are the key points:
· Private health insurers and employer group health plans should reimburse providers for COVID-19 testing in an amount that equals a previously negotiated rate or the cash price for the service, as it is listed on a provider’s public website. However, payers also may negotiate a rate that is lower than the cash price.
· Providers are required to list their cash price for COVID-19 diagnostic tests on their public websites. If they do not do this or complete a corrective action plan, the Department of Health and Human Services may impose civil monetary fines of up to $300 per day.
The requirement to post prices for COVID tests publicly, part of the CARES Act specifically, reflects a larger goal of the administration to push providers to publish prices for 300 of what the agency calls “shoppable services,” or those treatments and procedures—such as joint-replacement surgery—in which consumers may compare the prices charged by numerous organizations. Emergency services are not covered in this rule, which goes into effect in 2021. Hospital groups have filed a lawsuit in response to the rule.
In a separate effort, the Health Resources and Services Administration is reimbursing healthcare providers, generally at Medicare rates, for testing and treating uninsured patients for COVID-19.
When it comes to private payers, the government said they must cover molecular tests, antibody tests and other related tests with no out-of-pocket expenses, prior authorization or other medical-management requirements.
The covered services include urgent care visits, emergency room visits, and in-person or telehealth visits with a provider that result in an order for or administration of a COVID-19 test.
