New Federal Guidance Removes Barriers to COVID-19 Testing and Vaccinations

In accordance with an Executive Order signed by President Biden on Jan. 21, 2021, the federal government has issued new guidance removing barriers to COVID-19 diagnostic testing and vaccinations, and strengthening requirements that plans and issuers cover diagnostic testing without cost sharing.

Issued by the Centers for Medicare & Medicaid Services (CMS), together with the Departments of Labor and Treasury, this guidance clarifies that private group health plans and issuers generally cannot deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19. Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer.

For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested at no cost. It also confirms that plans and issuers must cover point-of-care COVID-19 diagnostic tests, as well as COVID-19 diagnostic tests administered at state or locally administered testing sites.

In addition, the guidance includes information for providers on how to get reimbursed for COVID-19 diagnostic testing or for administering the COVID-19 vaccine to those who are uninsured. For example, the Provider Relief Fund Program enables providers to submit claims and seek reimbursement on a rolling basis for COVID-19 testing, treatment and vaccinations to uninsured individuals.

Notably, the Health Resources & Services Administration Uninsured Program has already reimbursed providers more than $3 billion for the testing and treatment of uninsured individuals, and expects to see increased claims as states scale up their vaccination efforts.

To learn more, access the new federal guidance.


Pacific Federal is a Zenith American company and subsidiary of Harbour Benefit Holdings, Inc.