Dive Brief:
- Congressional Democratic committee leaders penned a letter to federal regulators raising concerns about insurers not covering COVID-19 testing more broadly, pointing to instances in which testing for "return to work" programs were not covered.
- The leaders, from both the House and Senate, believe CMS guidance delivered June 23 conflicts with the intent of earlier legislation and lets insurers off the hook when it comes to covering all testing. In part, the lawmaking was intended to have testing covered broadly to ensure widespread access even if it's intended for surveillance efforts and not a direct diagnosis.
- The lawmakers are calling for immediate action from HHS along with the U.S Departments of Labor and Treasury "to clarify the obligations of group health plans and insurers to provide robust and comprehensive coverage of COVID-19 testing," according to the Tuesday letter.
Dive Insight:
The number of coronavirus cases continues to soar in the U.S., prompting some states to roll back reopening plans and some health system operators to again halt elective surgeries.
Public health officials have repeatedly cited the importance of scaling testing in the country to help contain the spread of the novel coronavirus in order to restart local economies safely.
To achieve widespread access to testing, Congress passed both the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, which include provisions that require insurers to cover testing at no cost to members.
However, the guidance issued by CMS seems to undermine the intent of the law, according to a letter signed by five Democratic lawmakers including Rep. Frank Pallone, D-N.J., chairman of the House Energy and Commerce Committee; and Sen. Ron Wyden, D-Ore., ranking member of the Senate Finance Committee.
That guidance says testing conducted for "general workplace health and safety" such as return to work programs or for any other reason outside of an individualized diagnosis is "beyond the scope" of the FFCRA.
In their letter, lawmakers cite "troubling reports" of instances when testing wasn't covered. They call it unacceptable to give insurance companies "loopholes" when it comes to testing.
The insurance lobby did not refute the lawmakers claims in an email to Healthcare Dive. However, an America's Health Insurance Plans spokesperson did say insurers "stand ready to work with public health officials, employers, healthcare providers, policymakers, and others to develop and execute robust strategies to protect Americans, to identify cases, and reduce the spread of the virus."
