Updated on: March 23, 2020

Legislative Update: All Parties Agree, Testing Will Be Free

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Original story posted on: March 18, 2020

EDITOR’S NOTE: This is a developing story subject to change.

The goal of both state governments and Congress last week was to remove any economic obstacles for people to get tested for COVID-19. State and federal leaders wanted to make sure that people don’t hesitate in getting tested, for economic reasons – and from self-quarantining, if they have to.

At this point, it looks pretty certain that testing for the virus will not require any copays, coinsurance, or any other cost sharing by any individual, whether that person is insured or not. That is due to a bill that came out of the U.S. House of Representatives this past Saturday with strong bipartisan support.

As you remember, although it feels like a lifetime ago, just a week and a half ago, Congress and the President passed their first coronavirus bill, a funding package that was aimed mostly at getting a vaccine for the virus.

In contrast, the bill passed out of the House this past Saturday is directed at some of the economic repercussions of the virus on patients and workers. The bill still has to go through the Senate and be signed by the President, but Trump did tweet his support for the bill on Friday, so it is expected to be made law by midweek.

The bill called the “Families First Coronavirus Response Act,” addresses a number of areas:

First, as we said, the bill waives all costs for any individual who gets tested for the virus. The bill also prohibits any payor from requiring prior authorization for getting tested.

For people who are infected or quarantined, or whose workplace or children’s school has been closed, the bill requires businesses to offer paid sick leave and up to three months of paid family and medical leave. These requirements, however, only apply to businesses with fewer than 500 employees. The applicability to just medium-sized businesses is likely to remain in place as the bill goes through the Senate and the President because Republicans fought hard to keep a cap on the paid leave. The cost won’t fall on businesses, however; the government will provide tax credits to pay for it.

The bill also provides funds for the administration of state unemployment offices, and bolsters food assistant programs. You may have heard that the administration was going ahead with applying work requirements to the food stamp program. This bill would halt that plan.

An incredible amount of state government activity last week complemented the provisions of the House bill.  

Nearly 30 states came out with provisions for insurers with regard to the billing and payment of coronavirus-related issues. See the attached table that lists these states and the emergency provisions they passed.

Table of State Coronavirus Actions 3.15.20B

Ten states announced strict requirements on insurers, while another 19 states requested insurer’s compliance or came to agreements with specific insurers. Among those state announcements, commonalities included: waiving any cost sharing for testing (like the House bill), requiring insurers to waive prior authorization for testing, and prohibiting other restrictive utilization management processes. Some states also included telehealth provisions and requirements that insurers allow prescription refills before scheduled refill dates, so that people wouldn’t have to go to a pharmacy when they should be practicing social distancing.

In the coming days, we’re likely to see a wave of the next category of government intervention: mandates on social distancing. On Sunday, the Centers for Disease Control and Prevention (CDC) strongly recommended cancelling or postponing events, across the country, with 50 or more people. This past weekend, Illinois, Ohio, and Washington State – plus Boston and New York City – have put out emergency orders that either severely restrict restaurants and bars, or shut them down completely.

If there’s a silver lining to this period, it’s that this week, state governments and Congress moved quickly – and, more importantly, worked together, across party lines – to fight the coronavirus and its potentially disastrous effects.   

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

This email address is being protected from spambots. You need JavaScript enabled to view it.

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