Text of Agency ACA Implementation FAQS, Part 43: FFCRA and CARES Act (PDF)
"Set out [in this document] are frequently asked questions (FAQs) regarding implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to Coronavirus Disease 2019 (COVID-19). These FAQs have been prepared jointly by the [DOL], the Department of Health and Human Services (HHS), and the Department of the Treasury.
- Are self-insured group health plans required to comply with the requirements of section 6001 of the FFCRA?
- How can a plan or issuer determine which COVID-19 tests are required to be covered under section 6001(a)(1) of the FFCRA?
- In FAQs Part 42, the
Departments clarified that coverage for certain items and services must be provided consistent with the requirements of section 6001 of the FFCRA 'when medically appropriate for the individual, as determined by the individual's attending health care provider.' How should plans and issuers determine if a provider is the attending health care provider?
- Are plans and issuers required to cover COVID-19 tests intended for at-home testing under section 6001 of the FFCRA?
- Is COVID-19 testing for surveillance or employment purposes required to be covered under section 6001 of the FFCRA?
- If an individual receives multiple diagnostic tests for COVID-19, are plans and issuers required to cover each test, as well as other applicable items and services?
- If a facility fee is charged for a visit that results in an order for or
administration of a COVID-19 diagnostic test, must the plan or issuer also cover the facility fee without imposing cost-sharing requirements?
- Do the reimbursement requirements of section 3202(a) of the CARES Act apply to any items and services other than diagnostic testing for COVID-19?
- Does section 3202 of the CARES Act protect participants, beneficiaries, and enrollees from balance billing for a COVID-19?
- How do the requirements of section 3202(a)(2) of the CARES Act interact with state balance billing laws regarding reimbursement for items and services furnished by out-of-network providers or providers that do not have a negotiated rate with a plan or issuer for COVID-19 tests?
- How should plans and issuers determine a reimbursement rate for providers of COVID-19 testing if they do not have a negotiated rate with the provider and the provider has not made available on a public internet website the cash price of a COVID-19 diagnostic test, as required by section 3202(b) of the CARES Act?
- If an individual receives a COVID-19 test in an emergency department of a hospital that is out-of- network, how do the requirements of section 3202(a) of the CARES Act interact with PHS Act section 2719A?
- In FAQs Part 42, the Departments announced temporary enforcement relief that allows plans and issuers to make changes to coverage to increase benefits, or reduce or eliminate cost
sharing, for the diagnosis and treatment of COVID-19 or for telehealth and other remote care services more quickly than they would otherwise be able to under current law. May a plan or issuer also revoke these changes upon the expiration of the public health emergency related to COVID-19 without satisfying advance notice requirements?
- In light of the COVID-19 pandemic, may a large employer offer coverage only for telehealth and other remote care services to employees who are not eligible for any other group health plan offered by the employer?
- If a grandfathered group health plan or issuer of grandfathered group or individual health insurance coverage adds benefits, or reduces or eliminates cost-sharing requirements, for the diagnosis and treatment of COVID-19 or for telehealth and other remote care services during the public health or national emergency period related
to COVID-19, will the plan or coverage lose its grandfather status solely because it later reverses these changes upon the expiration of the COVID-19 emergency period?
- When performing the 'substantially all' and 'predominant' tests for financial requirements and quantitative treatment limitations under the MHPAEA regulations, may plans and issuers disregard benefits for items and services required to be covered without cost sharing under section 6001 of the FFCRA?
- May a plan or issuer waive a standard for obtaining a reward (including any reasonable alternative standard) under a health-contingent wellness program if participants or beneficiaries are facing difficulty in meeting the standard as a result of circumstances related to COVID-19?
- What are the potential consequences of delaying the individual coverage HRA notice to the extent
permitted by EBSA Notice 2020-01?"
Employee Benefits Security Administration [EBSA], U.S. Department of Labor [DOL]; U.S. Department of Health and Human Services [HHS]; and U.S. Department of the Treasury
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