Reimbursement: Congress Calls on Insurers to Cover Coronavirus Testing without Charging Patients

As labs scramble to come up with a coronavirus detection assay and CMS creates a billing and coding regimen, Congress is working to ensure that private payors provide coverage of SARS-CoV-2 testing. On March 6, the U.S. House of Representatives passed a bill requiring insurers to cover all testing without passing costs on to patients.

The Bill

The coronavirus provisions are part of a larger appropriations bill called the Families First Coronavirus Response Act (HR 6201). Among other things, it instructs insurers that offer group and individual health plans to cover SARS-CoV-2 diagnostics with Emergency Use Authorization (EUA) from the FDA. HR 6201 also calls on insurers to waive deductibles, copayments and coinsurance for patients and refrain from following their usual prior authorization and other utilization management requirements for such tests. The bill covers costs associated with tests provided during the course of a patient’s visit to a doctor, urgent care center or emergency room.

The Senate is now considering its own version of the bill and President Trump has suggested that he will support it.

A Potential Loophole: Non-EUA Tests

The way HR 6201 is written, it applies only to tests that have received EUA from the FDA, including assays from the U.S. Centers for Disease Control and commercial tests from Roche and Thermo Fisher. But under the FDA’s coronavirus response strategy, the agency is permitting high-complexity labs to validate and administer their own tests while seeking EUA within 15 days. It’s unclear whether HR 6201 would apply to those tests, which have been launched by LabCorp and Quest Diagnostics, among others. Is the inclusion of just EUA tests an oversight or deliberate? Industry organizations have called on to Congressional leaders to revise the language to fix the omission, if that’s, in fact, what it is.



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