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CMS publishes FAQs on essential health benefit coverage and the coronavirus

March 13, 2020
Area(s) of Interest: Public Health Practice Management 


The Centers for Medicare and Medicaid Services (CMS) today published an FAQ on essential health benefit coverage (EHB) and the novel coronavirus (COVID-19).

The FAQ details existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19. The document clarifies which COVID-related services, including testing, isolation/quarantine and vaccination, are generally currently covered as EHBs in these markets. As questions and issues continue to come to CMS, they will be addressed and added to these FAQs.

Many payors have already announced they will be treating COVID-19 diagnostic tests as covered benefits and will be waiving cost-sharing that would otherwise apply to the tests. California Governor Gavin Newsom also yesterday ordered health insurance companies operating in California to waive member cost-sharing amounts for screening and testing for the COVID-19 disease.

Patients should contact their insurer to determine specific benefits and coverage policies, as these details may vary.

These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. For the latest information from the White House Coronavirus Taskforce, visit coronavirus.gov. For information specific to CMS, see the agency’s Current Emergencies web page.

The California Medical Association (CMA) has also set up a COVID-19 resource page, where you will find links to the latest news, research and developments on the COVID-19 outbreak for physicians and other health care providers.

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