by Jane Anderson
As more employers turn to COVID-19 testing to see if employees
are safe to return to the workplace, the Trump administration has clarified
that insurers must cover only physician-ordered "medically necessary"
diagnostic and antibody tests.
The guidance, released jointly on June 23 by HHS, the Dept. of
Labor and the Dept. of the Treasury, also says self-funded employer plans must
pay for COVID-19 testing that's medically appropriate.
"Testing conducted to screen for general workplace health
and safety (such as employee 'return to work' programs), for public health
surveillance for SARS-CoV-2, 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 the requirements embedded in the
legislation approved by Congress earlier this year that requires insurers to
pay for COVID-19 testing, the FAQ document said.
"I think now that [the insurers] have had this
clarification, they're going to use that as part of their determination of
coverage," Ashraf Shehata, KPMG national sector leader for health care and
life sciences, tells AIS Health.
Richard Hughes IV, managing director at Avalere Health, says
that it's possible to argue that Congress intended insurers to cover all tests
for their members, regardless of whether a physician ordered them, whether the
person was symptomatic, or whether the test was needed to return to work.
However, Hughes says it's also possible to argue that Congress
gave CMS the authority to implement these testing requirements with some
restrictions. "There could be tremendous variability across payers'
approaches to coverage policy and how they process claims," he says.
In fact, many insurers already have moved to limit testing
coverage in some ways, although their policies are fluid and have been updated
frequently, says Danielle Showalter, principal at Avalere.
Individuals whose plans will not cover a test can turn to what
Shehata calls the "retail model," which is direct-to-consumer
COVID-19 testing sites that don’t require a health care provider's permission.
Costs vary for this type of testing, which generally wouldn’t be covered by
insurance unless the person is symptomatic.
No comments:
Post a Comment