Changes to COVID-19 Coverage and Payment Requirements

Cross References

IR-2023-86, April 18, 2023 Under the Families First Coronavirus Response Act (FFCRA), enacted on March 18, 2020, group health plans and health insurance issuers offering group or individual health insurance coverage, including grandfathered health plans, are required to provide benefits for certain items and services related to diagnostic testing for the detection of SARS-CoV-2 (the virus that causes COVID-19) or the diagnosis of COVID-19. This requirement applies to items or services furnished during any portion of the public health emergency beginning on or after March 18, 2020. The CARES Act, enacted on March 27, 2020, amended the FFCRA to include a broader range of diagnostic items and services that plans and issuers must cover without any cost-sharing requirements, prior authorization, or other medical management requirements.

These requirements were to continue until the public health emergency ends.

The IRS is reporting that the public health emergency for COVID-19 is scheduled to end on May 11, 2023. As a result, plans and issuers are not required to provide coverage for items and services related to diagnostic testing for COVID-19 that are furnished after May 11, 2023. If they provide such coverage, they may impose cost-sharing requirements, prior authorization, or other medical management requirements for the items or services. See irs.gov/newsroom for links to more information about the ending of the COVID-19 coverage requirements.