On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.
1332 State Innovation Waivers: What Can Be Waived?
Manatt Health Solutions
The State Network 1332 Waivers Affinity Group continued with a webinar presentation by the team at Manatt Health Solutions. The initial webinar for this affinity group focused on the basics of the waiver process, as well as information on statutory guardrails and what can and cannot be waived. This most recent webinar investigates waiver possibilities more deeply, with more information on specific examples of what can be waived through this process. The webinar includes a brief review of the 1332 process, as well as in depth examples of what can be waived pertaining to a variety of areas, including QHPs and EHBs, exchanges, cost sharing, tax credits, and the individual and employer mandates.