March 18, 2020
Today, the Centers for Medicare & Medicaid Services (CMS) issued Frequently Asked Questions (FAQs) to clarify coverage for the diagnosis and treatment of the Coronavirus Disease 2019 (COVID-19) by catastrophic health plans. A catastrophic health plan generally may not provide coverage of an essential health benefit before an enrollee meets the plan’s deductible. Through these FAQs, CMS is announcing that the agency will not take enforcement action against any health issuer that amends its catastrophic plans to provide coverage without imposing cost-sharing requirements for COVID-19 related services before an enrollee meets the catastrophic plan’s deductible. CMS encourages states to take a similar enforcement approach.
The purpose of this use of CMS’ enforcement discretion is to remove barriers and financial disincentives to COVID-19 diagnosis and treatment. The FAQs issued today align with guidance the Internal Revenue Service (IRS) released last week, which provides flexibility to high deductible health plans to provide health benefits for diagnosis and treatment of COVID-19 without application of a deductible or cost-sharing.
The link to the related FAQs can be found here: https://www.cms.gov/CCIIO/Resources/Files/Catastrophic-Coverage-of-COVID-19.pdf
These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.