Health Plan Weekly

Weeks after the Trump administration released guidance saying private health insurers don’t have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict.

The guidance sought to clarify provisions of the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which state that insurers must pay for COVID-19 testing and associated services with no cost sharing for consumers or “medical management requirements” such as prior authorization. In a document issued jointly by HHS, the Dept. of Labor and the Treasury Dept. (HPW 6/29/20, p. 1), the agencies clarified that insurers must only pay for diagnostic or antibody testing conducted for “individualized diagnosis or treatment” that takes place “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”

The COVID-19 pandemic has caused visits to primary care providers (PCPs) to plummet, putting significant financial strain on those businesses. That crisis has been especially harmful to independent practices, and insurers have begun to step in to assist struggling practices in their networks.

In recent years, payers have also renewed their focus on investing in high-quality primary care, recognizing the central role primary care plays in population health, care coordination and preventive medicine.

On June 30, the Trump administration released the first major update to regulators’ guidance on vertical mergers and acquisitions since 1984. The document from the Federal Trade Commission and Dept. of Justice (DOJ) has already drawn controversy, as two FTC officials issued dissenting statements arguing the guidelines aren’t critical enough of deals that consolidate multiple parts of a supply chain.

However, health care and legal experts aren’t convinced that the new guidelines will provide much more assistance to firms hoping to execute vertical transactions akin to insurer Cigna Corp. buying PBM Express Scripts, pharmacy giant CVS Health Corp. buying insurer Aetna, or UnitedHealth Group — which already owns an insurer and a PBM — purchasing a bevy of care-delivery assets.

Insurers are taking steps to help providers financially as the COVID-19 pandemic progresses, in part to help stave off more provider consolidation and demands for higher reimbursement, a recent survey from Robert Wood Johnson Foundation and the Urban Institute showed.

However, insurers haven’t seen the need for changes to benefit design in response to the crisis, and most have not yet seen a significant drop in coverage among employer clients, particularly those offering large group coverage, the survey found. In addition, insurers’ experience with COVID-19-related costs so far leads them to believe that the financial impact on 2021 costs and premiums will be minimal.