Debate Lingers Over COVID-19 Testing Payment Rules

Weeks after the Trump administration released guidance saying private health insurers don’t have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict.

The guidance sought to clarify provisions of the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which state that insurers must pay for COVID-19 testing and associated services with no cost sharing for consumers or “medical management requirements” such as prior authorization. In a document issued jointly by HHS, the Dept. of Labor and the Treasury Dept. (HPW 6/29/20, p. 1), the agencies clarified that insurers must only pay for diagnostic or antibody testing conducted for “individualized diagnosis or treatment” that takes place “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”

© 2021 MMIT

Leslie Small

Leslie has been reporting and editing in various journalism roles for nearly a decade. Most recently, she was the senior editor of FierceHealthPayer, an e-newsletter covering the health insurance industry. A graduate of Penn State University, she previously served in editing roles at newspapers in Pennsylvania, Virginia and Colorado.

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