In The News

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests

As part of its ongoing efforts across many channels to expand Americans’ access to free testing, the Biden-Harris Administration is requiring insurance companies and group health plans to cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health coverage can get them for free starting January 15th.  The new coverage requirement means that most consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up front and ensures individuals do not need an order from their health care provider to access these tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those test costs covered by their plan or insurance. Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions…

…Over-the-counter test purchases will be covered in the commercial market without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements. 

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For more information, please see these Frequently Asked Questions.

Click Here for additional details on the requirements.

 

Updated Materials Available – Visiting Nursing Homes During Omicron Surge

The Centers for Medicare & Medicaid Services (CMS) has updated [their] Nursing Home Resource Center with two new informational products.

As of January 6, 2022, the Nursing Home Visitation FAQs have been updated to provide additional guidance about visitation during the Omicron surge. CMS has also created an infographic to graphically represent how to safely conduct visits to nursing homes during this time of spiking COVID cases around the country. These two new resources are available for nursing home providers, patients, caregivers, and CMS partners to stay informed about CMS’ latest thinking for keeping nursing homes safe in the current COVID climate.

 

Supreme Court Blocks Biden's Covid Requirements for Businesses, Upholds Health Care Workers Mandate

By NBC News By Pete Williams

WASHINGTON — The Supreme Court on Thursday blocked the Biden administration's rule requiring larger businesses to ensure that workers receive the Covid vaccine or wear masks and get tested on a weekly basis.

But the court said a separate mandate requiring vaccinations for an estimated 20 million health care workers can be enforced.

The workplace rule, announced last fall by the Occupational Safety and Health Administration, required companies with 100 or more employees to ensure that their workers either get vaccinated or wear masks and show negative Covid test results at least once a week.

The rule would have covered nearly 80 million American workers, and OSHA estimated it would save over 6,500 lives and prevent 250,000 hospitalizations in the next six months.

"Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly," the court's conservative majority said. "Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category."

In their dissent, the three liberal justices on the court said OSHA was well within its authority and expertise to impose the mandates, unlike the court, which they said was "lacking any knowledge of how to safeguard workplaces, and insulated from responsibility for any damage it causes."

"In the face of a still-raging pandemic, this court tells the agency charged with protecting worker safety that it may not do so in all the workplaces needed," the liberal justices wrote. "As disease and death continue to mount, this court tells the agency that it cannot respond in the most effective way possible. Without legal basis, the court usurps a decision that rightfully belongs to others. It undercuts the capacity of the responsible federal officials, acting well within the scope of their authority, to protect American workers from grave danger."

In a statement released later Thursday, President Joe Biden celebrated the verdict in the health care worker case as one that would "save lives," but said he was "disappointed" that the broader workplace mandate was struck down.

"I am disappointed that the Supreme Court has chosen to block common-sense life-saving requirements for employees at large businesses that were grounded squarely in both science and the law," he said, calling on individual businesses to institute their own vaccination requirements.

"We have to keep working together if we want to save lives, keep people working, and put this pandemic behind us," he added.

The Biden administration's workplace rule, announced in November, was immediately challenged by a group of businesses and Republican states that said the government lacked the power to issue such a sweeping mandate. Lower courts initially blocked the requirement, but a later ruling allowed it to go into effect.

In lifting the earlier stay, a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit called the OSHA rule "an important step in curtailing the transmission of a deadly virus that has killed over 800,000 people in the United States, brought our health care system to its knees, and cost hundreds of thousands of workers their jobs."

The National Federation for Independent Businesses called the appeals court ruling "a gut punch to America's small businesses who are struggling to stay in business as they come out of the pandemic."

Karen Harned, executive director of the group's small business legal center, called the Supreme Court ruling a "welcome relief" to businesses struggling to keep afloat during the pandemic. She expressed optimism that with the OSHA rule now halted, the lower courts will proceed to find the regulation illegal.

"As small businesses try to recover after almost two years of significant business disruptions, the last thing they need is a mandate that would cause more business challenges," Harned said.

Health Care Workers Mandate

The Supreme Court on Thursday said a separate regulation that requires vaccinations for health care workers who treat Medicare and Medicaid patients could be enforced. Two federal appeals courts had blocked enforcement in 24 states, but the requirement went into effect in the remaining 26.

States opposed to the requirement said the federal law gave the government the authority to impose general health and safety rules for facilities like hospitals, but did not confer the power to require vaccines. The agency that administers Medicare and Medicaid has never before required vaccinations, they said.

Four conservative justices — Clarence Thomas, Neil Gorsuch, Samuel Alito, and Amy Coney Barrett — disagreed with the majority and said they would have struck down the mandate for health care workers. The two justices who opposed the broad worker mandate but supported the health care worker requirement were Brett Kavanaugh and the chief justice, John Roberts.

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HHS Kicks Off New Year with New Protections from Surprise Medical Bills

Dear all,

January 1, 2022, new federal protections championed by the Biden-Harris Administration will shield millions of consumers from surprise medical bills—unexpected bills from an out-of-network provider, out-of-network facility or out-of-network air ambulance provider. The protections, implemented under the No Surprises Act, ban surprise billing in private insurance for most emergency care and many instances of non-emergency care. They also require that uninsured and self-pay patients receive key information, including overviews of anticipated costs and details about their rights.

In addition to shielding millions of consumers from surprise medical bills, these protections will further President Joe Biden’s work to promote competition in health care and other sectors of the American economy.

“The No Surprises Act is the most critical consumer protection law since the Affordable Care Act,” said Health and Human Services (HHS) Secretary Xavier Becerra. “After years of bipartisan effort, we are finally providing hardworking Americans with the federal guardrails needed to shield them from surprise medical bills. We are taking patients out of the middle of the food fight between insurers and providers and ensuring they aren’t met with eye-popping, bankruptcy-inducing medical bills. This is the right thing to do, and it supports President Biden’s vision of creating a more transparent, competitive and fair health care system.”

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

Both insured and uninsured/self-pay individuals who are concerned that their rights have been violated now have access to a host of tools, including a help desk (available at 800-985-3059, 8am-8pm ET seven days a week; TTY: 800-985-3059) and webpage (CMS.gov/nosurprises), where more details on registering potential violations can be found.

For more information, please see the following:

Lily Griego, Regional Director, U.S. Department of Human Services 

 

CGS:  NOA Processing Issue – Reason Code 32114

Home Health NOAs submitted via EMC are returning to the provider (RTP) with reason code 32114 in error. To prevent any late NOAs, please use the following workaround:

  • Access the NOA in the DDE Claims Correction screen.
  • Enter the nine-digit ZIP code.
  • F9/resubmit the claim.

To avoid this edit, you may choose to submit NOAs via DDE (rather than EMC) until a system fix can be implemented.

If an NOA is late due to this issue, indicate the following in the Remarks field of the final claim: Jan 2022 Issue RE 32114.

 
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