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.
Overview of Final Exchange Regulations
Manatt Health Solutions
On March 12, 2012, the Department of Health and Human Service (HHS) issued final and interim final rules governing the Establishment of Exchanges and Qualified Health Plans; and Exchange Standards for Employers under the Patient Protection and Affordable Care Act (ACA). These final rules represent the most significant guidance to date on the operation of Exchanges, setting forth the minimum standards Exchanges must meet, including: those related to eligibility and enrollment into qualified health plans and insurance affordability programs; the minimum requirements for issuers to offer plans through the Exchange; and, the standards for employers to participate in the Small Business Health Options Program (SHOP).
The purpose of this document, authored by Manatt Health Solutions, is to provide an overview of the final rules. Section I provides a high level overview of important highlights, focusing on key areas where HHS has changed or expanded upon previous guidance. Section II provides a more detailed summary of the regulations.