Not Making Insurers Pay for Back-to-Work COVID-19 Testing May Leave Labs Holding the Bag

Who should pay for desperately needed COVID-19 testing? In the first stage of the public health crisis, the federal government’s answer was that insurers should pay the bills and not pass along the costs to patients. But now the administration is backing away from that policy by indicating that insurers don’t have to pay for COVID-19 return-to-work testing of employees provided by employers as a preventive infection control measure. And if insurers aren’t on the hook, labs that furnish the tests could end up footing the bill. Here’s a rundown of the situation.

FFCRA Rules for COVID-19 Test Payment

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 sole responsibility for employer screening tests not used for diagnosis and treatment?

On June 23, we learned that the apparent answer is NO when the Departments 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.”

Congressional Democrats Ask Administration to Change Its Mind

On July 7, Democratic leaders of key House and Senate health committees sent a letter asking the Trump administration to revise its policy. Exempting insurers from paying for return-to-work COVID-19 testing violates the clear free testing intent of the FFCRA legislation. “It is unacceptable that this Administration’s priority seems to be giving insurance company loopholes instead of getting people the free testing they need,” the letter contends.

Whether the letter is right or wrong, the fact that it was signed only by Democrats will limit its actual influence.

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.”

The good news is that the issue is likely to be revisited now that the administration and Congress are gearing up to adopt a new round of COVID-19 relief legislation that will probably address payment of return-to-work COVID-19 testing.    



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