CMS Orders Medicare Advantage Plans, MACs to Cover COVID-19 Tests Under New Nursing Home Guidance

The Centers for Medicare & Medicaid Services (CMS) on Friday instructed Medicare Advantage plans and Medicare Administrative Contractors (MACs) to begin covering all COVID-19 tests required for nursing home residents under new testing guidelines.

The move came after the Centers for Disease Control & Prevention (CDC) updated its guidance around nursing home testing strategies last week.

“CMS instructed Medicare Administrative Contactors and notified Medicare Advantage plans to cover coronavirus disease 2019 (COVID-19) laboratory tests in nursing home residents and patients,” CMS noted in its announcement. “This instruction follows the Centers for Disease Control and Prevention’s (CDC) recent update of COVID-19 testing guidelines for nursing homes that provides recommendations for testing of nursing home residents and patients with symptoms consistent with COVID-19 as well as for asymptomatic residents and patients who have been exposed to COVID like in an outbreak.”

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Beginning July 6, Medicare and Medicare Advantage plans will cover COVID-19 lab tests under four primary categories laid out by the CDC:

  • Viral testing of residents
  • Initial viral testing in response to an outbreak
  • Recommended testing to determine resolution of infection
  • Public health surveillance

The coverage will continue for the duration of the federal COVID-19 public health emergency; tests deemed non-diagnostic will not be covered.

“Medicare Advantage plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services,” CMS admonished in its announcement.

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