Updated on: April 15, 2020

News Alert: CMS Moves to Waive Costs for the Privately Insured

Original story posted on: April 13, 2020

The federal agency has announced waivers on a rolling basis over the last month.

Federal officials announced over the weekend that they would be waiving costs of COVID-19 diagnostic testing and related services for the privately insured.  

The Centers for Medicare & Medicaid Services (CMS), together with the U.S. Departments of Labor and the Treasury, have issued guidance as part of a broader effort to stem the tide of the viral pandemic, and “to remove financial barriers for Americans to receive necessary COVID-19 tests and health services, as well as encourage the use of antibody testing that may help to enable health care workers and other Americans to get back to work more quickly.” 

“It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” CMS Administrator Seema Verma said in a statement. “Today’s action under the leadership of President Trump allows millions of Americans to access the vital health services they need to fight COVID-19.”

CMS noted in a press release that representatives of major health insurance companies met with President Trump last month, after which they “voluntarily committed” to covering COVID-19 testing without cost sharing such as co-pays and coinsurance. The recently enacted Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that private health issuers and employer group health plans cover COVID-19 testing and certain related items and services furnished during the pandemic, with no out-of-pocket expenses. 

Federal officials said the latest announcement includes care given during urgent care visits, emergency room visits, and in-person or telehealth visits to the doctor’s office that result in an order for or administration of a COVID-19 test. Such covered tests include all FDA-authorized COVID-19 diagnostic tests, COVID-19 diagnostic tests that developers request authorization for on an emergency basis, COVID-19 diagnostic tests developed in and authorized by states, and antibody testing – once it becomes “broadly available,” a timetable for which remains unclear.  

“(Antibody testing) could become a key element in fighting the pandemic by providing a more accurate measure of how many people have been infected and potentially enabling Americans to get back to work more quickly,” CMS said in its press release.

The number of diagnosed COVID-19 cases is approaching 2 million globally, with more than 115,000 deaths – including more than 550,000 cases and 22,000 deaths in the U.S.

To review the guidance in its entirety, go online to https://www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf.

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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