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CMS Issues Additional COVID-19 Testing and Vaccination Coverage Guidance

The Centers for Medicare and Medicaid Services (CMS) alongside the Department of Labor and Department of the Treasury issued new guidance related to COVID-19 diagnostic testing and vaccinations for health payers.

The guidance clarifies that private group health plans cannot use medical screening criteria to deny coverage of COVID-19 diagnostic tests for individuals who are asymptomatic and who have no known or suspected exposure to COVID-19. Health plans must cover the test without cost sharing, prior authorization, or other requirements. The guidance also clarifies that health payers must cover point-of-care COVID-19 diagnostic tests and COVID-19 tests administered at state or local testing sites.

The guidance also clarified existing federal policy requiring coverage of the COVID-19 vaccine. The guidance highlighted the ability for healthcare providers to seek reimbursement for COVID-19 testing and vaccines for uninsured individuals the Provider Relief Fund and HRSA COVID-19 Uninsured Program.

The full guidance is available on the CMS website.

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