June 11, 2021
On May 15, 2021, the California Department of Managed Health Care (DMHC) emergency regulation regarding COVID-19 testing expired. However, health plans must continue to cover certain COVID-19 testing for their enrollees pursuant to federal law. DMHC recently sent an all plan letter reminding payors that both the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (CARES Act) require plans to cover COVID-19 diagnostic testing, regardless of whether they access such tests through in- or out-of-network providers. Health plans may not require any type of prior authorization for testing and may not impose medical management/utilization management criteria on testing.
For more information, see the DMHC all plan letter.