Insurers are not required to cover COVID-19 tests that employers may mandate as they bring employees back to work, according to guidance released Tuesday by the Trump administration.
Insurers had been waiting for clarity from the administration on whether they would be on the hook for potentially repeated COVID-19 screening tests as states relax social distancing restrictions and employees return to work. The Families First Coronavirus Response Act required insurers to cover COVID-19 tests without patient cost-sharing, but Tuesday's guidance clarified that the law only applies to tests that are deemed "medically appropriate" by a healthcare provider.
"Testing conducted to screen for general workplace health and safety (such as employee "return to work" programs), for public health surveillance for SARS-CoV-2, or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19 or another health condition is beyond the scope of section 6001 of the [Families First Coronavirus Response Act]," the guidance from HHS, the Department of Labor, and Department of the Treasury states.
America's Health Insurance Plans said testing for public and occupational health services should be supported by more government funds.
"As the country reopens and returns to work, these strategies must include more federal guidance as well as funding for testing," AHIP spokesperson David Allen said.
House Energy & Commerce Chair Frank Pallone (D-N.J.) said in a written statement that he is concerned that the guidance will disproportionately impact frontline workers struggling to make ends meet while giving a handout to the insurance industry.
"HHS's new guidance appears to violate Congress' clear legislative intent that coronavirus testing be free of cost for all consumers," Pallone said.
Consumer advocacy group Families USA also voiced concern that the guidance adds a layer of complexity for consumers trying to figure out how to get tested, and said states don't have resources to fill the gap.
"We need clear guidance about when back-to-work testing is helpful, and insurers should cover that," said Cheryl Fish-Parcham, Director of Access Initiatives at Families USA.
As healthcare utilization plummeted, the nation's largest health insurers came out of the first quarter virtually unscathed financially from the coronavirus pandemic. But AHIP commissioned a study that found diagnostic testing could cost the U.S. between $6 billion and $25 billion annually, and antibody testing could cost $5 billion to $19 billion.
Nursing homes will be among the employers most impacted by the new testing coverage guidance. Some states require the facilities to test employees regularly and CMS recommends weekly testing.
The American Health Care Association/National Center for Assisted Living said they hope insurers will voluntarily decide to foot the bill for the tests anyway.
"Repeated, ongoing testing is the only way we are going to beat this virus. We hope that insurers will understand this and cover the costs," AHCA/NCAL said in a statement.
AHCA/NCAL estimated that testing all employees of nursing homes and assisted living facilities once would cost $672 million.
The American Clinical Lab Association said the guidance creates "widespread gaps in coverage" for COVID-19 testing and undermines Congress' testing coverage mandate. The group is also worried labs will get stuck with some of the cost.
"While there is widespread agreement that this testing is necessary, the issue of how these tests will be paid for remains unclear. Laboratories cannot — and should not be expected to — absorb the costs for return to work and surveillance testing," ACLA President Julie Khani said in a written statement.
James Gelfand, the senior vice president of health policy at The ERISA Industry Committee, said the new guidance is consistent in finding that the testing coverage mandate for insurers does not apply to tests administered solely for public health applications.
"We know testing is important for reopening the economy, and hope Congress and the administration can help ensure adequate resources are available to support the testing needed," Gelfand said in a statement.
Employers can require employees to be tested before returning to work, but the Pacific Business Group on Health said it would be highly unusual for a large employer to require testing for employees without paying for the tests in full.
"We would not anticipate employees to be on the hook for the cost of a COVID test if taking one is a requirement of them going back to work," PBGH senior director Lauren Vela said.
The National Association of Insurance Commissioners in May asked HHS to clarify guidance on coverage requirements for tests used for surveillance purposes, and a spokesperson said the new guidance will be helpful to states.