November 03, 2020
On October 2, 2020, the California Department of Insurance (CDI) published an FAQ on COVID-19 testing and coverage. The FAQ incentivizes COVID-19 testing and screening and clarifies that for CDI regulated insurance products, insurers are:
Required to waive patient cost sharing for COVID-19 testing and screening.
Responsible for payment of the waived cost sharing to providers for applicable services. They may not deduct the cost sharing that must be waived out of the provider’s payments.
This differs significantly from the Department of Managed Health Care (DMHC’s) emergency regulations on COVID-19 testing, effective on July 17, 2020, which created a cumbersome three-tiered testing prioritization structure and imposes different cost sharing, prior authorization and diagnostic testing benefit requirements for each tier.
The California Medical Association (CMA) appreciates the clear guidance published by CDI. CMA continues to have significant concerns that the DMHC emergency regulation limits and delays access to testing, creates a barrier to accessing diagnostic testing, particularly for minority and marginalized communities, and creates an unworkable operational requirement. CMA escalated these concerns in an August 24, 2020, letter to the Newsom Administration.