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Are Out-of-Pocket Costs on Their Way Out? At-Home COVID-19 Testing and Expanded Preventative Healthcare for Women and Children

In response to a directive from the White House, based on provisions of the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief and Economic Security (CARES) Act that eliminated cost sharing for COVID-19 diagnostic testing, three federal government departments—the US Department of Health and Human Services (HHS), the US Department of Labor (Labor) and the US Department of the Treasury (Treasury)—issued guidance in the form of frequently asked questions (FAQs) that states group health plans and insurers must also cover over-the-counter (OTC) COVID-19 diagnostic testing. This guidance is effective beginning January 15, 2022.

In addition, the Health Resources and Services Administration (HRSA) updated the Affordable Care Act’s (ACA) comprehensive preventive care and screening guidelines for women and children to cover additional services and supplies without a copay or deductible, effective 2023.

COVID-19 AT-HOME TESTING COVERAGE

On January 10, 2022, HHS, Labor and the Treasury together issued FAQs that elaborated on prior guidance and indicated that group health plans and insurers are required to cover OTC COVID-19 diagnostic tests without cost sharing. Because of the recent spike in COVID-19 cases resulting from the rapid spread of the Omicron variant, the guidance will continue for the duration of the public emergency.

Most consumers with private health coverage will be able to buy OTC COVID-19 tests and either have the cost covered upfront or be reimbursed later by submitting a claim to their health plan. The new requirement only applies to “diagnostic” OTC COVID-19 testing. It does not include the treatment of COVID-19 or testing that is for employment purposes.

The guidance provides that health plans and insurers must cover at least eight OTC COVID-19 diagnostic tests per covered individual per a 30-day period. Insurers will be able to set up networks of preferred suppliers to provide OTC COVID-19 tests directly to participants without upfront costs. Insurers must still reimburse OTC COVID-19 tests purchased outside the direct coverage program, however, the reimbursable amount is limited to $12 per test if the health plan also provides tests through its preferred pharmacy network and through a direct-to-consumer shipping program without upfront costs.

Besides the risk of increasing the average cost of OTC COVID-19 tests, the new initiative raises concerns over fraud and abuse. For health plans and insurers to protect themselves, the FAQs provide several examples of permissible activities to prevent fraud and abuse, like requiring proof of purchase or an attestation that the test was purchased for proper purposes (i.e., is being used by the covered individual, is not being reimbursed by another source, is not being resold and is not for employment purposes).

HRSA UPDATES ACA PREVENTIVE HEALTHCARE GUIDELINES

On January 11, 2022, HRSA announced that it updated the preventive health and screening guidelines for women, infants, children and adolescents. Under the ACA, certain group health plans and insurers must provide coverage with no out-of-pocket costs for preventive health services within these HRSA-endorsed comprehensive guidelines.

HRSA accepted the updates recommended by the Women’s Preventative [...]

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COVID-19 Laws and Regulations: A Midyear Update

As employers navigate evolving COVID-19 state and federal rules, workplaces will have to stay vigilant about changes throughout the second half of 2021. These include changes to mask mandates, the Occupational Safety and Health Administration’s Emergency Temporary Standard and the New York Health and Essential Rights (HERO) Act.

Recent US Equal Employment Opportunity Commission guidance, for example, confirmed what employment lawyers had already been counseling businesses to do, according to McDermott partner Carole A. Spink in a recent Law360 article.

“The guidance was important because it did clarify that employers can provide incentives for voluntary programs. [There] was a big open question about, ‘Am I going to get into trouble because I’m trying to incentivize people to be vaccinated?'”

Access the article.




Global Employment Law Update

Employment law continues to evolve, and it can be a challenge amid an ever-changing landscape of local employment laws for human resources executives and employment counsel at multinational businesses to maintain a consistent global corporate culture.

McDermott’s Global Employment Law Update brings you the key highlights from across Asia, Africa, Europe, Latin and North America. Developed in collaboration with peer firms operating in more than 50 countries, this resource guide contains summaries of the laws and significant court decisions that impacted employers and employees all over the world. It includes:

  • COVID-19 legislative updates
  • Remote work and telecommuting policies
  • Data privacy protections
  • Minimum wage and salary compensation updates
  • Changes to labor protection laws
  • Sexual harassment modifications

Access the report.




American Rescue Plan Act of 2021: Key Healthcare Provisions

On March 10, 2021, US Congress finalized and passed the American Rescue Plan of 2021 (ARPA), the latest COVID-19 relief package that largely tracks President Joe Biden’s initial $1.9 trillion proposal. The ARPA extends unemployment insurance benefits and provides direct $1,400 stimulus payments to qualifying Americans, but it also makes several important health policy-related changes. These include providing funding for vaccine distribution and testing to combat the COVID-19 pandemic, making policy adjustments to the Medicaid program, facilitating health insurance coverage and providing more money for healthcare providers. The final bill also makes two narrowly focused technical Medicare payment changes.

This summary highlights notable health policy provisions of the final bill.

Access the summary.

For more information, please contact Meg Gilley, Mara McDermott, Kristen O’Brien, Katie Waldo, Rodney Whitlock or Eric Zimmerman.




American Rescue Plan Act of 2021: Employment Law Update

US President Joe Biden signed into law the $1.9 trillion American Rescue Plan Act of 2021 (ARPA) on March 11, 2021. ARPA follows from weeks of negotiations in Congress and attempts to facilitate the country’s recovery from the impact of the COVID-19 pandemic.

Included in ARPA are several provisions that impact employers, including provisions on paid leave, reduced hours and employee retention credits. Employers should be mindful of the employment-specific changes put into effect by ARPA and accordingly update their policies and practices to comply with these changes.

Access the article.




Healthcare Employers: What You Need to Know about the New FFCRA “Health Care Provider” Exclusion and California COVID-19 Supplemental Paid Sick Leave

Healthcare employers are immediately impacted by two recent developments in federal and California COVID-19 paid leave laws: a Department of Labor revision to the Families First Coronavirus Response Act (FFCRA) and a new California supplemental paid sick leave legislation. For both changes in the law, quick action is required for compliance.

Access the article.




Employer Considerations for Remote and In-Person Workers as the School Year Commences

With the school year underway, employers in the United States face a new challenge: childcare-related leave and accommodation requests by employees. With widespread remote learning and evolving legal obligations to provide paid leave to working parents, employers must navigate unique staffing challenges while complying with the Families First Coronavirus Response Act (FFCRA) and other state and local leave laws. In our recent webinar, we outlined some of the current leave requirements regarding childcare obligations and practical solutions to navigate these uncharted waters.

View the slide deck here.




New California Law SB 1159 Creates Workers’ Compensation Presumption for Certain Eligible Employees

On September 17, 2020, California Governor Gavin Newsom signed SB 1159 into law, which is effective immediately for all employers. Among other things, the law creates a “disputable presumption” under workers’ compensation statutes for certain employees with confirmed cases of COVID-19 and establishes reporting requirements on confirmed cases and number of employees.

Access the article.




California COVID-19 Supplemental Paid Sick Leave Act (AB 1867): Paid Leave, Notice and Posting Requirements Effective Immediately

On September 9, 2020, California Governor Gavin Newsom signed into law Assembly Bill 1867, the California COVID-19 Supplemental Paid Sick Leave Act. According to the law, employers with more than 500 employees nationally, and employers of healthcare-provider and emergency-responder employees previously exempted from Families First Coronavirus Response Act (FFCRA) requirements, must provide California employees with two weeks of supplemental paid sick leave for specified COVID-19 reasons. Additionally, the law requires employers to comply with urgent-notice and posting requirements that are administratively burdensome.

Access the article.




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