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Coverage Requirements for COVID-19 Testing: A Refresher

January 14, 2021

The Families First Coronavirus Response Act (“FFCRA”) requires group health plans and health insurance issuers to provide coverage for COVID-19 diagnostic testing and related items and services without cost-sharing or prior authorization or other medical management requirements. This requirement is in effect from March 18, 2020 through the end of the declared public health emergency for the COVID-19 pandemic.

Public Health Emergency vs. National Emergency

The public health emergency is separate from the national emergency for COVID-19. The public health emergency is declared and periodically renewed by the Secretary of Health and Human Services. On January 7, 2021 the HHS Secretary extended the public health emergency declaration for the COVID-19 pandemic. It was scheduled to expire on January 20, but will now extend to April 20 and possibly later if extended again. The national emergency is declared by the President and is open ended. The testing coverage requirement is tied to the public health emergency while the Timeline Extension Rule is tied to the national emergency.

Testing Requirement Did Not Require Annual Renewal

The FFCRA ties the requirement for testing coverage to the public health emergency timeline. Therefore, it does not expire at the end of 2020 and did not need to be extended or renewed in the recent end of year legislative package. Rather, it will end with the declared public health emergency.

Workplace Surveillance Testing Not Included

According to agency guidance, the FFCRA's requirement for no cost-sharing coverage of COVID-19 tests applies only where the test (and accompanying goods and services) is for individual diagnostic purposes.

Clinical decisions about testing are made by the individual’s attending health care provider and may include testing of individuals with signs or symptoms compatible with COVID-19, as well as asymptomatic individuals with known or suspected recent exposure to the virus, that is determined to be medically appropriate by the individual’s health care provider, consulting CDC guidelines as appropriate. However, testing conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition is beyond the scope of section 6001 of the FFCRA.

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