March 1, 2021

Volume XI, Number 60

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March 01, 2021

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Families First Coronavirus Response Act Imposes Benefit Mandates on Insurers and Group Health Plans

In a much needed sign of bipartisanship, the Senate passed and President Trump signed last night  the Families First Coronavirus Response Act.  The new law is effective today and requires insurers and group health plans to provide coverage for FDA-approved COVID-19 testing and related items and services.  The mandated coverage applies during the current state of emergency.  Here are some highlights of the new law.

  • Group health plans and issuers of individual and group health insurance plans (including grandfathered plans) must provide coverage without cost-sharing or pre-authorization or other medical management requirements for the following COVID-19-related testing services (“Testing”):

▪ FDA-approved testing for COVID-19 and the administration of such testing.

▪ Items and services furnished to individual during health care provider office visits (including in-person and telehealth visits), urgent care center visits, and emergency room visits that result in an order for or administration of a test for COVID-19. The mandate applies only to the extent the items and services relate to the furnishing or administration of the test or to the evaluation of the individual for purposes of determining the need for testing.

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  • Original Medicare coverage for Testing will be at 100%. The Medicare coinsurance and deductible will not apply.
  • Medicare Advantage organizations must also provide coverage for Testing without cost-sharing or pre-authorization or other medical management requirements. For more information related to the obligations of Medicare Advantage organizations, please refer to our March 12, 2020 post.
  • State Medicaid and CHIP programs are required to cover Testing without cost-sharing. States may expand their Medicaid programs to cover Testing for the uninsured.  The Medicaid federal medical assistance percentage is temporarily increased.
  • Similar coverage requirements for Testing are imposed on the health insurance programs for the military, veterans and federal civilians as well as the Indian Health Service.
Copyright © 2020, Sheppard Mullin Richter & Hampton LLP.National Law Review, Volume X, Number 79
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About this Author

Christine Clements, Sheppard Mullin Law Firm, Washington DC, Corporate and Health Care Law Attorney
Partner

Christine M. Clements is a partner in the Healthcare Team in the firm's Washington, D.C. office with 25 years of experience on managed care law issues. Ms. Clements focuses her practice on federal healthcare government contract programs, with particular focus on the Medicare Advantage Program, the Medicare Prescription Drug Benefit, the Federal Employees Health Benefits Program, Medicaid managed care, and the Medicare-Medicaid Plans. Ms. Clements advises clients on the issues most important to them, including contract applications and service area expansions, responses...

202-747-1848
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