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.
2017 Innovation Waivers: The Future is Right Around the Corner Webinar
Deborah Bachrach, Michael Kolber, and Joel Ario, Manatt Health Solutions
Section 1332 of the Affordable Care Act permits states to request innovation waivers from the Departments of Health and Human Services (HHS) and Treasury of certain ACA requirements, with waivers first effective in 2017. This waiver process has attracted some attention from thought leaders, but the states, the requesting parties on any waiver applications, have been focused on more pressing ACA implementation issues. That is changing as states begin to consider their longer term goals for health reform and specifically the opportunities afforded by section 1332 waivers.
In order to help states jump start their thinking about 1332 waivers, experts from Manatt Health Solutions presented the regulatory framework for those waivers and offered some examples that illustrate the broad range of potential waivers and the guardrails that ensure waivers continue to meet the goals of the ACA. This webinar addressed which ACA provisions are waivable, including the individual mandate, the employer mandate, essential health benefits, and exchange standards; how the coverage and fiscal guardrails might be applied by HHS and Treasury, which have yet to provide much guidance beyond a regulation that defines the waiver application process; and how 1332 waivers might be combined with Medicaid 1115 waivers to better achieve state goals across programs. The webinar slides can be found at the “download” button and a webinar recording can be found here.