HHS said it will refuse to change its guidance letting insurers off the hook for paying for COVID-19 tests that employers may mandate for employees to return to work, and lawmakers appear unlikely to force a legislative change.
If Congress doesn't address the issue, who gets stuck with the potentially big bill for COVID-19 tests for occupational and public health purposes could remain a gray area. The Trump administration issued guidance on June 23 that exempted health insurers from covering COVID-19 tests that aren't deemed medically necessary by a healthcare provider. The interpretation creates a loophole though which individuals could be charged.
Democrats asked the administration to reconsider the guidance on Tuesday, but there isn't a coordinated push to include a legislative clarification in the upcoming COVID-19 relief package. An HHS spokesperson said Friday that HHS isn't changing its guidance, and that states should use the $10.25 billion lawmakers appropriated for testing to fill the gap.
"HHS will not be changing our policy. Insurance companies are required to cover diagnostic testing for their members without imposing any cost sharing, but surveillance testing is a public health activity and should be paid for differently," an HHS spokesperson said.
Stakeholders want federal and state governments to foot the bill for tests that fall in the gray area. A study commissioned by America's Health Insurance Plans found overall diagnostic testing could cost between $6 billion and $25 billion annually.
One of the most notable industries that will be impacted is nursing homes, as several states require them to test their employees regularly. The American Health Care Association/National Center for Assisted Living estimated that testing all nursing home and assisted living community residents and employees just once could cost $672 million. The federal government recommends staff be tested weekly.
AHCA/NCAL said expecting providers to cover ongoing testing with existing assistance funds is unreasonable because of increased staffing demands, rising costs for PPE, and fixed overhead costs.
"Given the gravity of the situation we are facing with this deadly virus and its impact on our vulnerable residents, it is essential that long term care facilities have additional support and funding from state and federal governments to reduce the spread," AHCA/NCAL said in a written statement.
On the House side, the Education & Labor Committee appears the most likely to weigh in. A Democratic aide said the committee is weighing whether additional legislation is needed to address testing gaps, including worksite-based testing.
But an aide for Ways & Means Committee Democrats said that the House Democrats already passed legislative fixes in their opening bid for the next COVID-19 bill, which would put guardrails on Provider Relief Fund money and would provide hazard pay for healthcare workers, including nursing home staff.
Senate Democrats also aren't planning further legislative action to counter the Trump administration's guidance, said a source familiar with the issue. Their position is that the onus is on the administration to make a change because the legislative intent was clear that insurers should pay for all COVID-19 tests without cost-sharing.
Stakeholders including AHIP, the Blue Cross Blue Shield Association, and the American Clinical Lab Association have called on the federal government to cover tests for occupational safety and public health purposes that may not have to be covered by insurers.
"We strongly support federal funding to account for the magnitude of tests that will be required to get the economy back on track, reduce the risk of transmission in different settings, and understand the progression of the disease," AHIP and BCBSA wrote to congressional leaders on Friday.
Some Republican lawmakers are interested in shoring up the policy after the Trump administration's guidance, but not necessarily by making insurers pay the bill. A GOP Senate Finance Committee aide said the issue is under discussion, and that Republicans are interested in targeting any solution to the most vulnerable populations.
A bill authored by Senate Finance Chair Chuck Grassley (R-Iowa) and two GOP senators in tough re-election races, Sens. Steve Daines (R-Mont.) and Martha McSally (R-Ariz.), would require any federal aid provided to nursing homes and assisted living facilities to be used for buying personal protective equipment and providing COVID-19 testing for their employees for 60 days.
HHS on May 22 sent $4.9 billion to skilled-nursing facilities from the $175 billion Provider Relief Fund lawmakers created to help providers offset lost revenue and coronavirus-related expenses.