Reimbursement

Feds Say Insurers Not Required to Pay for Employer Return to Work COVID-19 Testing

Since the public health emergency began, the US government has taken the position that insurers shouldn’t be allowed to make consumers pay for COVID-19 lab tests. But now comes news that insurers will not be put in that same position with regard to return to work screening conducted on employees by their employers. And while the plan is for employers to pay for that testing, labs that perform COVID-19 screening tests may get left holding the bag.

FFCRA Rules for COVID-19 Test Payment

The key piece of federal relief legislation, the Families First Coronavirus Response Act (FFCRA), required insurers to cover COVID-19 tests without imposing any copayments, deductibles, coinsurance or other patient cost-sharing. But the rule (Section 6001 of FFCRA) rule applied only to tests deemed “medically appropriate” by a healthcare provider. The key question: Would insurers also have to foot the bill for screening tests not used for diagnosis and treatment?

Apparently, the answer is no. On June 23, the Department of Labor, HHS and Treasury issued joint guidance (FAQ 5) clarifying that Section 6001 doesn’t apply to “testing conducted to screen for general workplace health and safety (such as employee “return to work” programs, for public surveillance or any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19.”

Takeaway: Significance for Labs

So, if insurers aren’t on the hook, the consumers, i.e., employers will have to pay for return to work screening. Of course, this may discourage many employers from offering such testing in the first place—other than employers in skilled nursing and other high-risk facilities in which screening testing is mandated by state or local law.

 As with the original Section 6001 rule, labs may once more get caught in the middle and end up having to pay at least some of the cost. “While there is widespread agreement that this testing is necessary, the issue of how these tests will be paid for remains unclear,” American Clinical Laboratories Association President Julie Khani in a written statement. “Laboratories cannot — and should not be expected to — absorb the costs for return to work and surveillance testing.”  


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