[Official Guidance]

Text of Agency FAQs, Part 42: FFCRA and CARES Act Implementation (PDF)

12 pages, Apr. 11, 2020. "[The] approach [of the Departments of Labor, Health and Human Services, and the Treasury] to implementation is and will continue to be marked by an emphasis on assisting (rather than imposing penalties on) group health plans, health insurance issuers and others that are working diligently and in good faith to understand and come into compliance with the new law. The Departments anticipate issuing additional guidance about the FFCRA, the CARES Act, and other health coverage issues related to COVID-19.... [N]othing in the FFCRA or the CARES Act prevents a state from imposing additional standards or requirements on health insurance issuers with respect to the diagnosis or treatment of COVID-19, to the extent those standards or requirements do not prevent the application of a federal requirement. [Questions answered in the FAQs are:]

1. Which types of group health plans and health insurance coverage are subject to section 6001 of the FFCRA, as amended by section 3201 of the CARES Act?
2. When are plans and issuers required to comply with section 6001 of the FFCRA and for how long?
3. What items and services must plans and issuers provide benefits for under section 6001 of the FFCRA?
4. Do 'in vitro diagnostic tests' described in section 6001(a)(1) of the FFCRA, as amended by section 3201 of the CARES Act, include serological tests for COVID-19?
5. The FFCRA requires plans and issuers to cover items and services provided during a visit that 'relate to the furnishing or administration' of COVID-19 diagnostic testing or that relate 'to the evaluation of such individual for purposes of determining the need' for diagnostic testing. What types of items and services must be covered pursuant to this requirement?
6. May a plan or issuer impose any cost-sharing requirements, prior authorization requirements, or medical management requirements for benefits that must be provided under section 6001(a) of the FFCRA, as amended by section 3201 of the CARES Act?
7. Are plans and issuers required to provide coverage for items and services that are furnished by providers that have not agreed to accept a negotiated rate as payment in full (i.e., out-of-network providers)?
8. Section 6001(a)(2) of the FFCRA requires plans and issuers to provide benefits for certain items and services that are furnished during healthcare provider office visits, which include in-person and telehealth visits, as well as visits to urgent care centers and emergency rooms. Under what circumstances are items or services considered to be furnished during a visit?
9. In light of the COVID-19 public health emergency, will the Departments permit plans and issuers to amend the terms of a plan or coverage to add benefits, or reduce or eliminate cost sharing, for the diagnosis and treatment of COVID-19 prior to satisfying any applicable notice of modification requirements and without regard to otherwise applicable restrictions on mid-year changes to health insurance coverage in the group and individual markets?
10. May states impose additional requirements on health insurance issuers to respond to the COVID-19 public health emergency?
11. May an employer offer benefits for diagnosis and testing for COVID-19 under an EAP that constitute an excepted benefit?
12. May an employer offer benefits for diagnosis and testing for COVID-19 at an on-site medical clinic that constitute an excepted benefit?
13. How can plans and issuers use telehealth and other remote care services to mitigate the impact of the COVID-19 public health emergency?
14. In light of the public health emergency posed by COVID-19, will the Departments allow plans and issuers to add benefits, or reduce or eliminate cost sharing, for telehealth and other remote care services prior to satisfying any applicable notice of modification requirements and without regard to restrictions on mid-year changes to provide coverage for telehealth services?"

U.S. Department of Labor [DOL], U.S. Department of Health and Human Services [HHS], and U.S. Department of the Treasury