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Covid-19 Aid Bill May Impose Testing Mandate on Self-Insured Group Plans

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The U.S. Capitol (Credit: Allison Bell/ALM)

House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin appear to be negotiating a Covid-19 emergency aid bill that would impose a new Covid-19 testing benefits mandate on self-insured employer health plans as well as on fully insured group health plans.

Pelosi, a Democrat, said late Thursday, during remarks to reports, that one key goal of the bill is to remove barriers to testing for severe acute respiratory coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19.

“What we’re trying to do is be in a positive vein and go forward, in a way, working together, so we can have people be tested, tested, tested,” Pelosi said, according to a transcript of her remarks provided by the House. “That’s what’s really important.”

Resources

  • A House documents page that includes a link to the latest version of H.R. 6201 is available here.
  • A transcript of the Pelosi press conference is available here.
  • An earlier article about H.R. 6201 is available here.

On Wednesday, Pelosi said in statement, “We cannot fight coronavirus effectively unless everyone in our country who needs to be tested knows they can get their test free of charge.”

The House is now in recess. It has put a note on its website saying that the next meeting is subject to the call of the chair.

Sen. Tina Smith, D-Minn., has introduced H.R. 3499, a stand-alone Covid-19 testing benefits bill, in the Senate. That bill has 39 sponsors. All of the sponsors are Democrats, or independents who caucus with the Democrats.

Medicare program 91 administrators said Thursday they’ll pay about $35.91 for SARS-CoV-2 testing done in government laboratories and $51.31 for testing done in other labs.

Self-Funded Plan Basics

Federal regulators let large employers form self-insured health plans, outside the jurisdiction of state insurance regulators, under the Employer Retirement Income Security Act of 1974.

About 58 million people get coverage through self-insured employer health plans, according to Mark Farrah Associates.

Employers, their groups and some insurers have argued that self-funded health plans can often provide better benefits more efficiently than fully insured plans can, because the sponsors can design the benefits without having to comply with 50 separate sets of state benefits regulations.

For years, many state insurance regulators and some insurers have argued that one concern about self-funded plans is that they fall outside the scope of state benefits package standards.

Some of the Affordable Care Act (ACA) benefits standards, such as provisions requiring plans to provide coverage for measles shots and mammograms without imposing co-payments or deductibles on the patients, do apply to self-funded plans.

Other federal and state standards, such as the ACA standards that require individual and small group insurance policies to cover at least about 60% of the actuarial value of a standard health benefits package, do not.

H.R. 6201: The Families First Coronavirus Response Act Bill

House leaders posted a copy of H.R. 6201, the Families First Coronavirus Response Act bill, on  a House website Tuesday.

The 124-page bill deals with many matters, including unemployment insurance for people affected by SARS-CoV-2 quarantines, paid sick days for people affected by the outbreak, and a paid leave program for people affected by the quarantines.

Division G, Section 101, of that bill would set standards for health coverage for Covid-19 testing.

The section would require any “group health plan” or “health insurance issuer,” including the older, “grandfathered” plans that are exempt from the usual Affordable Care Act coverage standards, to provide coverage for Covid-19 testing,.

Affected plans would have to cover Covid-19 testing during a Covid-19 emergency period without imposing deductibles, co-payment requirements, coinsurance requirements, prior authorization requirements, or other cost-sharing or medical management requirements.

The definition of “group health plan” used in the version of the bill posted Tuesday appears to apply the cost-sharing waiver requirements to any self-insured health plan that would have to cover measles shots and other basic preventive services without imposing cost-sharing on the patient.

The U.S. Department of Health and Human Services, the U.S. Department of Labor, and the U.S. Treasury Department’s Internal Revenue Service would share responsibility for enforcing the Covid-19 testing mandate.

The mandate in the version of the bill posted Tuesday would not affect coverage for Covid-19 care.

Division G, Section 103, in the bill would provide $1 billion in support for states that set up emergency Covid-19 testing programs for uninsured people.

The paid leave section, Division D, would provide two-thirds of an individual’s average monthly earnings, up to $4,000 per month, during a 30-day period, for a quarantined individual or the individual’s caregiver.

The quarantine benefits would not to be subject to federal income taxes.

The Social Security commissioner would provide the benefits and could get reimbursed for the cost by the U.S. Treasury secretary.

— Read State Regulators, Health Insurers Muster for Coronavirus Fighton ThinkAdvisor.

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