May 1, 2021HHS limits the use of guidance documents in civil enforcement actions
March 19, 2020
The “Families First Coronavirus Response Act (“HR 6201”), signed by President Trump on March 18, 2020, includes the following rules that impact employers’ group health plans and employer costs incurred in providing group health plan coverage.
Group health plans (including fully-insured, self-insured and grandfathered) and health insurers are required to provide coverage and not impose any cost sharing requirements (including deductibles, copayments, and coinsurance) or prior authorization or other medical management requirements, for the following items and services:
The requirement to cover office, urgent care and ER visits only applies to the extent that the fees for the visit or services relate to (a) the furnishing or administration of the diagnostic testing or (b) the evaluation of the individual for purposes of determining the need for diagnostic testing. Thus, if the patient had visited the physician’s office for another reason (such as a post-surgery follow-up), presumably he or she would be responsible for the office visit fee, but not the cost of the diagnostic testing.
This requirement applies immediately on the date of enactment of the Act and continues until the end of the national emergency period.
The various secretaries of Health and Human Services, Labor and Treasury may issue additional guidance further explaining the provisions of this portion of the Act, so you should stay alert for anything they may issue.
Non-governmental employers who are required to pay wages under the Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act portions of HR 6201 (both of which will be addressed in a separate upcoming alert) will be able to recoup, in the form of tax credits against certain payroll taxes, the full employer cost of group health plan coverage that they provide during the paid portion of those emergency leaves. We will address these tax credits in more detail in an upcoming alert.
The clock is ticking. Employers (especially those with self-insured plans) should start working with their legal advisors and benefits consultants to consider any changes they need to make to their group health plans to comply with these new requirements.
The Employee Benefits and Executive Compensation team is ready to assist with questions or compliance steps. Please contact one of our Executive Compensation and Employee Benefits attorneys or the Nelson Mullins attorney with whom you work.
These materials have been prepared for informational purposes only and are not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Internet subscribers and online readers should not act upon this information without seeking professional counsel.