Seyfarth Synopsis: Late Friday evening, the House of Representatives overwhelmingly passed a bill (HR 6201) targeted to provide relief for individuals impacted by the spread of SARS-CoV-2, the coronavirus that causes COVID-19. The bill addresses paid sick leave and the expansion of FMLA. This post, however, is aimed at the provisions applicable to employers' medical plans.
From a benefits perspective the bill appears to apply broadly to all medical insurance plans, whether insured, self-funded, group or individual coverage. It also applies to Medicare, Medicaid, TRICARE, Tribal insurance, etc. The bill is sweeping enough to bring in all employer-sponsored group health plans (and multiemployer plans), including those that may still be grandfathered under the Affordable Care Act.
Notably, the law also contains federal funding to cover testing for the uninsured. This is helpful as many employers have inquired about members of their workforce who do not meet their major medical plans' eligibility criteria, but under current law it could be impermissible to offer a plan covering COVID-19 testing only and nothing more. If federal funding is available for this population, employers will feel some relief about trying to design a solution.
The bill focuses on the expansion of access to testing for the SARS-CoV-2 virus, or any other virus that could cause COVID-19, through "in vitro diagnostic products" approved by the FDA. Those are lab tests using blood or tissue samples. Such testing is to be covered without any cost-sharing requirements. That is, free.
While the bill is not so expansive as to directly cover all medical treatment following a diagnosis of COVID-19, it does cover all items and services furnished to an individual during health care provider office visits, urgent care center visits, and emergency room visits that result from an order for or administration of such testing for COVID-19. To be covered without cost-sharing, these items and services must be related to the furnishing or administration of the testing or to the evaluation of the individual to determine if s/he needs testing.
If the plan doesn't provide first dollar coverage for this type of testing and related services, it appears the plan would have to be modified to offer coverage. And if the plan imposes any form of cost-sharing, that would need to be waived.
While President Trump has thrown his support behind the Bill, resulting in support from the House Republicans as well, there have been mixed signals from the Senate. Majority Leader McConnell has expressed his intent to take up the Bill early this week, and at that point the timing (and substance) of a final law should become more clear.
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