Capitol Correspondence - 03.02.21

Biden Administration Strengthens Insurance Coverage of COVID-19 Testing

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We share this reporting by Politico Pro on insurance coverage of COVID-19 screening in case it assists our members as they seek to maintain the safety of their frontline staff during the pandemic.

“The Biden administration is revising a policy that let health insurers deny coverage of a broad swath of Covid-19 tests, according to highly anticipated guidance released on Friday. Yet the change falls short of forcing insurers to pay for screenings meant to monitor public health or reopen workplaces.

Health plans will now have to pay for more screenings for the virus, regardless of whether doctors order the tests or if patients seeking a test are asymptomatic. Insurers must also pay for point-of-care diagnostic tests administered at state or local testing sites.

‘Plans and issuers cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests,’ the new guidance states.

Yet the exemption for widespread public health screenings is a win for the health plans whose executives have insisted they shouldn’t be on the hook for funding broad coronavirus surveillance. The new policy ‘encourages’ health plans to communicate clearly with customers about when they won’t cover Covid-19 tests.

Laboratories and diagnostic manufacturers have spent months fighting the exemption, saying it limited the availability of testing needed to bring the pandemic under control. […]

Context: The fight over testing coverage emerged almost immediately after Congress passed its early mandates for insurers to cover the Covid-19 diagnostics — which had followed pledges from major insurance companies to do so. The Biden administration, in a recent executive order, indicated it was evaluating changing the previous guidance issued by the Trump administration.

Insurers have maintained they historically have not had to fund public health surveillance. Some state insurance regulators, even before the Trump administration had given them an out, had exempted health plans from paying for tests not deemed ‘medically necessary.’

Health plans also argued that Congress should at least limit what labs can charge for tests — citing costs in the thousands of dollars, mostly from out-of-network labs and free-standing hospitals.

What’s next: The new policy comes as nearly 70 million Americans have received at least the first dose of a Covid-19 vaccine — but as more contagious COVID variants are proliferating. The Biden administration has made further testing expansion a core part of its plan to get through the pandemic and is advocating for billions more for testing to be included in a $1.9 trillion relief package winding through Congress.”