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.
CARES Act Provider Relief Fund Resource Page
HHS Resource Page
- Main HHS landing page: States and providers may monitor this page for updates
- “General Information” section includes an overview of distributions, methodology, and timeline
- “For providers” section includes additional application details for each Provider Relief Fund distribution, such as the portal and terms and conditions
- “Data” section includes state-by-state information for each Provider Relief Fund distribution
- “FAQs” section includes questions and answers about the Provider Relief Fund periodically by HHS
- Enhanced Provider Relief Fund Payment Portal: To attest to receipt of certain Provider Relief Fund payments and to apply for the Medicaid/CHIP Provider Distribution
- General Distribution Portal: To submit tax forms/financial statements for the $20 billion “Tranche 2” General Distribution
- COVID-19 Uninsured Program Portal: To submit claims for providing COVID-19 testing or treatment for uninsured patients
- CARES Act Provider Relief Fund Payment Attestation Portal: to attest to receipt of the certain Provider Relief Fund payments
- HHS Announces Provider Relief Fund Payments for Medicaid Providers, Hot Spot and Safety Net Hospitals (6/11): Manatt analysis of recent allocations of the $175 billion Provider Relief Fund, including allocations for Medicaid providers, safety net and hot spot hospitals.
- HHS Distributes $22 Billion in Provider Relief Funds to Hot Spot and Rural Providers (5/5): Manatt analysis of payments to hot spot hospitals and rural providers.
- HHS Outlines Plans for $100 Billion Provider Relief Fund (4/24): Manatt Health analysis of how HHS plans to disburse provider relief fund payments to providers.
- HHS Begins to Distribute $30 Billion of the $100 Billion CARES Act Provider Relief Fund (4/10): Manatt Health analysis of disbursement of the first $30B in funding from the provider relief fund based on Medicare revenues.
- The Provider Relief Fund: How Well Does it Protect Patients from Surprise Medical Bills for COVID-19 Related Services?: Resource from Georgetown CHIR examining the interplay between the Provider Relief Funds and its impact on balance/surprise billing.