The U.S. Congress has passed comprehensive measures to ensure that Americans will not have to pay for COVID‑19 testing. The Texas Department of Insurance (TDI) expects insurers offering exclusive provider networks (EPOs) and health maintenance organizations (HMOs) to comply with these regulations, as they fall within the federal definitions for group health plans or health insurance issuers offering group or individual health insurance coverage.
The Families First Coronavirus Response Act (H.R. 6201), which went into effect March 18, 2020, requires coverage for the cost of administering COVID-19 testing and related office visits to health-care providers. Testing costs must be covered without imposing any cost-sharing, including deductibles, coinsurance, or copayment requirements. Testing coverage is required regardless of whether the services are provided during an in-person office visit with a health-care provider, a telehealth visit, an urgent care center visit, or an emergency room visit.
On March 27, President Trump signed an emergency aid package known as the Coronavirus Aid, Relief, and Economic Securities Act or CARES Act (H.R. 748), which reinforces the goal of making COVID‑19 testing free to Americans. Under the CARES Act, coverage should be provided with no cost-sharing, regardless of the network status of the provider or lab and regardless of whether the testing is done on an emergency basis. The CARES Act instructs health plans to pay a provider's negotiated rate or, if a health plan does not have a negotiated rate with the provider, pay the provider's publicly available cash price for testing.
As the market experiences changes in the availability of providers who are able to conduct COVID-19 testing and other medical services, TDI expects EPOs and HMOs to monitor and verify that their provider networks are adequate to handle increased demand and minimize the need for services outside the network. When a network provider is not reasonably available, carriers must ensure that the consumer is protected, as contemplated by the CARES Act and by Texas's laws.