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CMS Releases New Guidance Requiring Payors to Cover COVID-19 Testing Without Cost Sharing

NEW YORK – The Centers for Medicare and Medicaid Services on Friday released new guidance for insurers requiring them to cover SARS-CoV-2 diagnostic testing without cost sharing.

According to the guidance, private payors generally can't use medical screening criteria to deny coverage for COVID-19 testing for asymptomatic people with no known exposure to the virus. Regardless of whether a person has symptoms or has been exposed, the test must be covered if a licensed or authorized healthcare provider administers or has referred a patient for the test. This coverage must be offered without cost sharing, prior authorization, "or other medical management requirements imposed by the plan or issuer," CMS said in a statement. 

However, state and local public health authorities can require providers to limit eligibility for testing based on clinical risk or other factors to manage testing supplies and access to testing, CMS added. In addition, insurers aren't required to provide coverage of testing for public health surveillance or employment purposes.

The guidance also confirms that insurers must cover point-of-care COVID-19 tests and diagnostic tests administered at state or local sites. It reinforces the existing policy that allows providers to seek federal reimbursement for providing COVID-19 diagnostic testing or vaccines to people who are uninsured.

The American Clinical Laboratory Association praised CMS for clarifying coverage requirements, with President Julie Khani saying in a statement that the action "takes critical steps to close coverage gaps and protect access to the COVID-19 testing patients need."

Last week, the organization sent a letter to COVID-19 Response Coordinator Jeff Zients supporting President Biden's directive to federal agencies to clarify coverage of COVID-19 testing and encouraging the administration to increase funds to the Uninsured Test Fund for providers to receive reimbursement for providing SARS-CoV-2 tests to uninsured patients. So far, $1.8 billion of the $2 billion fund has been paid out to cover this testing, ACLA said.