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CMS: Insurance Companies Required to Cover At Home COVID-19 Tests

CMS NEWS
FOR IMMEDIATE RELEASE

January 10, 2022

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

Biden-Harris Administration Requires Insurance Companies and Group Health Plans to
Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests

As part of its ongoing efforts across many channels to expand Americans’ access to free testing,
the Biden-Harris Administration is requiring insurance companies and group health plans to
cover the cost of over-the-counter, at-home COVID-19 tests, so people with private health
coverage can get them for free starting January 15th. The new coverage requirement means that
most consumers with private health coverage can go online or to a pharmacy or store, buy a test,
and either get it paid for upfront by their health plan, or get reimbursed for the cost by
submitting a claim to their plan. This requirement incentivizes insurers to cover these costs up
front and ensures individuals do not need an order from their health care provider to access these
tests for free.

Beginning January 15, 2022, individuals with private health insurance coverage or covered by a
group health plan who purchase an over-the-counter COVID-19 diagnostic test authorized,
cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have those
test costs covered by their plan or insurance. Insurance companies and health plans are required
to cover 8 free over-the-counter at-home tests per covered individual per month. That means a
family of four, all on the same plan, would be able to get up to 32 of these tests covered by their
health plan per month. There is no limit on the number of tests, including at-home tests, that are
covered if ordered or administered by a health care provider following an individualized clinical
assessment, including for those who may need them due to underlying medical conditions.

“Under President Biden’s leadership, we are requiring insurers and group health plans to make
tests free for millions of Americans. This is all part of our overall strategy to ramp up access to
easy-to-use, at-home tests at no cost,” said HHS Secretary Xavier Becerra. “Since we took
office, we have more than tripled the number of sites where people can get COVID-19 tests for
free, and we’re also purchasing half a billion at-home, rapid tests to send for free to Americans
who need them. By requiring private health plans to cover people’s at-home tests, we are further
expanding Americans’ ability to get tests for free when they need them.”

Over-the-counter test purchases will be covered in the commercial market without the need for a
health care provider’s order or individualized clinical assessment, and without any cost-sharing
requirements such as deductibles, co-payments or coinsurance, prior authorization, or other
medical management requirements.

As part of the requirement, the Administration is incentivizing insurers and group health plans to
set up programs that allow people to get the over-the-counter tests directly through preferred
pharmacies, retailers or other entities with no out-of-pocket costs. Insurers and plans would
cover the costs upfront, eliminating the need for consumers to submit a claim for reimbursement.
When plans and insurers make tests available for upfront coverage through preferred pharmacies
or retailers, they are still required to reimburse tests purchased by consumers outside of that
network, at a rate of up to $12 per individual test (or the cost of the test, if less than $12). For
example, if an individual has a plan that offers direct coverage through their preferred pharmacy
but that individual instead purchases tests through an online retailer, the plan is still required to
reimburse them up to $12 per individual test. Consumers can find out more information from
their plan about how their plan or insurer will cover over-the-counter tests.

“Testing is critically important to help reduce the spread of COVID-19, as well as to quickly
diagnose COVID-19 so that it can be effectively treated. Today’s action further removes
financial barriers and expands access to COVID-19 tests for millions of people,” said CMS
Administrator Chiquita Brooks-LaSure.

State Medicaid and Children’s Health Insurance Program (CHIP) programs are currently
required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. In 2021, the
Biden-Harris Administration issued guidance explaining that State Medicaid and Children’s
Health Insurance Program (CHIP) programs must cover all types of FDA-authorized COVID-19
tests without cost-sharing under CMS’s interpretation of the American Rescue Plan Act of 2019
(ARP). Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR
and antigen tests, with no beneficiary cost-sharing when the test is ordered by a physician, nonphysician practitioner, pharmacist, or other authorized health care professional. People enrolled
in a Medicare Advantage plan should check with their plan to see if their plan offers coverage
and payment for at-home over-the-counter COVID-19 tests.

This effort is in addition to a number of actions the Biden Administration is taking to expand
access to testing for all Americans. The U.S. Department of Health and Human Services (HHS)
is providing up to 50 million free, at-home tests to community health centers and Medicare-certified health clinics for distribution at no cost to patients and community members. The program is intended to ensure COVID-19 tests are made available to populations and settings in need of testing. HHS also has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the Omicron surge, HHS and FEMA are creating surge testing sites in states across the nation.

For more information, please see these Frequently Asked Questions,http://For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/11022-faqs-otc-testing-guidance.pdf


For additional details on the requirements, visit https://www.dol.gov/sites/dolgov/files/EBSA/aboutebsa/our-activities/resource-center/faqs/aca-part-51.pdf

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NCAAA Has Funding Available to Support VAccine and Booster Outreach Activities

NCAAA has funding available to support vaccine and booster outreach activities!  

Overview

On March 29, President Biden announced that the administration was taking further action to expand access to COVID-19 vaccines. One action included in this expansion is that through a partnership between the Centers for Disease Control and Prevention (CDC) and the Administration for Community Living (ACL), ACL would provide nearly $100 million to help increase vaccinations among older adults and people with disabilities.  Check out our new Vaccine Support Services page.    
 
Context

The disproportionate number of cases and deaths among Black, Indigenous and People of Color (BIPOC) in the current Coronavirus pandemic exemplifies one of many health inequities that exist in our society. Such injustices reflect systemic ecological, economic, and social biases in our health and service provision infrastructure.

Summary

The North Central Area Agency on Aging, Inc. (NCAAA) is soliciting proposals for programs that serve older persons (age 60 and older), individuals with disabilities, and their caregivers in the North Central Connecticut Region. (See MAP.)   Successful applicants will target vaccine-related services to low-income groups, minorities, low-income minorities, rural residents, individuals with limited English proficiency, residents with severe disabilities, Individuals at risk of institutionalization, and/or individuals with Alzheimer’s and related disorders.

The following activities are eligible for funding (the RFP link is below under Timeframe):

·        Disseminating credible information about COVID-19 vaccines and help direct those with questions to additional sources of information,
·        Identifying people who may need help getting a COVID-19 vaccination, including those who are unable to independently travel to a vaccination site,
·        Helping with scheduling a COVID-19 vaccination appointment for those who need help,
·        Arranging or providing accessible transportation to COVID-19 vaccination sites,
·        Providing technical assistance to local health departments and other entities on vaccine accessibility,
·        Providing personal support if needed (e.g., peer support), and
·        Reminding the person of their second vaccination appointment if needed.  

Timeframe ·        RFP is NOW posted to the NCAAA Website under  

Services> Grant Funding>Health & Wellness

·        RFP Due Date:     February 1st, 2022
·        Projects Begins March 1st, 2022
·        Funding Expires:   September 30th, 2022    

Governor Lamont Activates First Severe Cold Weather Protocol of the Season as Frigid Temperatures Approach

Posted on January 10, 2022

(HARTFORD, CT) – Governor Ned Lamont today announced that as brutally frigid temperatures are expected to impact Connecticut over the next couple of days, he is directing the state’s severe cold weather protocol to be activated beginning at 12:00 p.m. on Monday, January 10, 2022, and remaining in effect through 12:00 p.m. on Wednesday, January 12, 2022. This is the first time the protocol has been enacted during the 2021-2022 winter season.

The purpose of the protocol is to ensure that the most vulnerable populations receive protection from the severe cold conditions, which could be life threatening if exposed to the elements for extended periods of time. While enacted, a system is set up for state agencies and municipalities to coordinate with United Way 2-1-1 and Connecticut’s network of shelters to make sure that anyone in need can receive shelter from the outdoors, including transportation to shelters.

Anyone in need is urged to call 2-1-1 to get connected to these services. Safety measures have been enacted at shelters and warming centers throughout Connecticut to adhere to the needs of the ongoing COVID-19 pandemic.

“While we’ve had relatively mild weather so far this winter, it looks like we are about to receive our first blast of freezing cold air beginning this evening,” Governor Lamont said. “Being outdoors in these arctic conditions for extended periods is not safe, and we must spread the word that shelters and warming centers are open all across Connecticut. If you or someone you know is in need of shelter, call 2-1-1 and they will direct you to a nearby location and they can also provide transportation if necessary.”

The following actions are implemented while the protocol is enacted:

The Connecticut Department of Emergency Services and Public Protection’s Division of Emergency Management and Homeland Security activates its WebEOC communications network, which is an internet-based system that enables local, regional, and state emergency management officials and first responders to share up-to-date information about a variety of situations and conditions. The system is used to monitor capacity at shelters across the state, enabling 2-1-1 to act as a clearinghouse to assist in finding shelter space for those who need it. Local officials, working through WebEOC, can alert 2-1-1 and the state when they open temporary shelters or warming centers.

The Connecticut Department of Social Services, Connecticut Department of Housing, and Connecticut Department of Mental Health and Addiction Services coordinate with 2-1-1 and the Connecticut Coalition to End Homelessness, along with community-based providers, to provide transportation for people seeking shelter.

For emergency management news and resources, visit the state’s CTPrepares website at ct.gov/ctprepares or download the CTPrepares app to mobile devices at the Apple App Store and the Google Play Store.  
Read on CT.gov

ACL: Federal Communications Commission Launches the Affordable Connectivity Program

Federal Communications Commission (FCC) Launches the Affordable Connectivity Program (ACP) On December 31, the FCC launched the ACP. This program, created by Congress in the Infrastructure and Jobs Act, is a longer-term replacement for the Emergency Broadband Benefit (EBB) program. This investment in broadband affordability will help ensure households can afford the internet connections they need for work, school, health care, and more.

The FCC also launched a toolkit of materials for partners to download and customize to meet their needs. More materials will be added in the coming weeks.

The ACP provides a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying tribal lands. Eligible households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers if they contribute more than $10 and less than $50 toward the purchase price.

Enrollment in the ACP is now open for households with at least one member qualifying under any of the following criteria: Has an income that is at or below 200% of the federal poverty guidelines. Participates in certain assistance programs, such as SNAP, Medicaid, Federal Public Housing Assistance, SSI, WIC, or Lifeline. Participates in tribal-specific programs, such as Bureau of Indian Affairs General Assistance, Tribal TANF, or Food Distribution Program on Indian Reservations. Is approved to receive benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision. Received a Federal Pell Grant during the current award year. Meets the eligibility criteria for a participating provider’s existing low-income program. The 9 million households fully enrolled in the EBB program as of December 31, 2021 will continue to receive their current monthly benefit until March 1, 2022. More information about steps current EBB recipients must take to continue receiving the ACP benefit after March 1, 2022 will be available in the coming weeks.

For application questions, email [email protected] or call 877-384-2575.
 

The theme for Older Americans Month 2022: “Age My Way”

Every May, the Administration for Community Living (ACL) leads the nation’s observance of Older Americans Month (OAM). In 2022, ACL will be focusing on aging in place – how older adults can plan to stay in their homes and live independently in their communities for as long as possible. The 2022 theme is Age My Way, an opportunity for all of us to explore the many ways older adults can remain in and be involved with their communities.

We’re going to be discussing how planning, participation, accessibility, and making connections all play a role in aging in place – emphasizing that what each person needs and prefers is unique.
 
The 2022 logos are available now. Stay tuned for a poster, social media graphics, and more that you can use to celebrate OAM in your community.

Don’t forget to follow #OlderAmericansMonth for the latest from ACL, and to see what others are planning!

Last modified on 01/06/2022

National Consumer Voice: CMS Updates FAQ on Nursing Home Visitation Guidance

CMS Updates FAQs on Nursing Home Visitation Guidance

On January 6, 2022, the Centers for Medicaid and Medicare Services (CMS) updated the Frequently Asked Questions (FAQs) released on December 23rd, 2021, which clarify their updated Nursing Home Visitation Guidance from November.

The updated FAQs continue to emphasize that visitation must be permitted at all times and state that visitation is critical for residents, acknowledging that past limits on visitation led to physical and psychosocial decline.

Key updates are below:

-While visitation should still occur, states may instruct facilities to take additional measures to make visitations safer, including wearing well-fitting masks, such as surgical or KN95s.  States should work directly with CMS on measures they are considering.

-When outbreaks occur, facilities should continue consulting with state and local health departments to determine when modifications to visitation policies are appropriate.  All discussions with the health department should be documented as should all measures facilities have taken to attempt to control the spread of COVID-19.

-Facilities should continue permitting visitation as cases spike due to the Omicron variant.    The guidance states that visitation must still be permitted despite rising cases and emphasizes residents’ federal right to make choices about their lives in a facility and their right to visitation (42 CFR 483.10(f)(2) and (4)).

Vaccination is strongly encouraged though not required and extra precautions for reducing the risk of COVID-19 transmission are suggested including providing dedicated indoor space for visitation, visiting when a roommate is not available, outdoor visitation, offering visitors surgical or K95 masks, restricting movement in the facility to the visitation location, increasing airflow and ventilation, cleaning and sanitizing after visits, not conducting visits in common areas, and posting reminders about COVID-19 infection prevention practices in common areas.

Consumer Voice strongly encourages all family members to follow all infection prevention protocols that facilities require while visiting, including proper masking, hand washing, social distancing, and rescheduling visits if you have symptoms of, or test positive for, COVID-19.  Additionally, we strongly advise all visitors to get vaccinated before visiting and to test if possible before entering a facility.

Center for Medicare Advocacy: Free Webinar, Medicare Coverage of Home Health Services

FREE WEBINAR | Medicare Coverage of Home Health Services

Wednesday, January 12, 2021 @ 2 – 3 PM EST

Medicare’s home health benefit offers coverage of a range of services for beneficiaries who qualify, but the benefit is often misunderstood. This free webinar by the Center for Medicare Advocacy will review the services the Medicare home health benefit covers, including skilled nursing; physical, occupational, and speech therapy; medical social services; and home health aides. The webinar will also discuss current challenges and possible strategies for beneficiaries who are trying to access or maintain home health services, especially if they have longer-term, chronic conditions. There will be an opportunity for questions for Center for Medicare Advocacy staff members.

Register Now:
https://attendee.gotowebinar.com/register/7879007285776193551