CMS Moves to Streamline Coverage and Reimbursement for COVID Testing and Vaccination

Federal officials are ordering plans and insurers to cover testing without cost-sharing – for virtually any purpose.

Federal officials have issued new guidance intended to streamline the process through which Americans can get easy, free access to COVID-19 diagnostic testing and/or vaccinations.

“This guidance makes clear that private group health plans and issuers generally cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19,” the Centers for Medicare & Medicaid Services (CMS) said in a press release issued jointly with the departments of Labor and Treasury. “Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer.”

That provision isn’t exclusive to acute circumstances – covered individuals even simply wanting to ensure that they are COVID-19-negative prior to visiting a family member should be able to be tested without paying cost sharing, officials said.

CMS said it issued the guidance in response to what it called “many questions about plan and issuer responsibility to cover COVID-19 diagnostic testing for individuals who are asymptomatic and have no known or suspected recent exposure to COVID-19.”

Officials said the guidance also “reinforces existing policy regarding coverage for the administration of the COVID-19 vaccine” and “highlights avenues for providers to seek federal reimbursement for costs incurred when administering COVID-19 diagnostic testing or a COVID-19 vaccine to those who are uninsured.” That includes obtaining reimbursement through the Provider Relief Fund program, which has a separate effort for providers to submit claims on a rolling basis for such services. Likewise, CMS noted, the HRSA Uninsured Program has already reimbursed providers to the tune of more than $3 billion for the testing and treatment of uninsured individuals, and it expects to see an influx of vaccine administration claims as states scale up their vaccination efforts.

“To further build awareness about the availability of this program, this announcement seeks comment on strategies to connect those without insurance to care from providers participating in this fund,” CMS said in its press release.

The global COVID-19 pandemic has sickened nearly 115 million worldwide and killed more than 2.5 million people, including approximately 29.3 million infections and 525,000 deaths in the U.S. alone.

The new guidance can be viewed online here: https://www.cms.gov/files/document/faqs-part-44.pdf