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The FFCRA and the CARES Act
The FFCRA was enacted on March 18, 2020.
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Section 6001 of the FFCRA generally requires
group health plans and health insurance issuers offering group or individual health insurance
coverage to provide benefits for certain items and services related to testing for the detection of
SARS-CoV-2, the virus that causes COVID-19, or the diagnosis of COVID-19 (generally
referred to collectively in this document as COVID-19) when those items or services are
furnished on or after March 18, 2020, and during the applicable emergency period.
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Under the
FFCRA, plans and issuers must provide this coverage without imposing any cost-sharing
requirements (including deductibles, copayments, and coinsurance), prior authorization, or other
medical management requirements.
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The CARES Act was enacted on March 27, 2020.
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Section 3201 of the CARES Act amended
section 6001 of 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.
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Section 3202(a) of the CARES Act generally requires
plans and issuers providing coverage for these items and services to reimburse any provider of
COVID-19 diagnostic testing an amount that equals the negotiated rate or, if the plan or issuer
does not have a negotiated rate with the provider, the cash price for such service that is listed by
the provider on a public website. (The plan or issuer may negotiate a rate with the provider that
is lower than the cash price.) Additionally, during the public health emergency related to
COVID-19 declared under section 319 of the Public Health Service Act (PHS Act), section
3202(b) of the CARES Act requires providers of diagnostic tests for COVID-19 to make public
the cash price of a COVID-19 diagnostic test on the provider’s public internet website or face
potential enforcement action including civil monetary penalties.
pandemic, and the same reasons underlying the issuance of the January 31, 2020 declaration that a public health
emergency exists, under section 319 of the PHS Act.
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Pub. L. No. 116-127 (2020).
5
On January 31, 2020, HHS Secretary Alex M. Azar II declared that as of January 27, 2020, a public health
emergency exists nationwide as the result of the 2019 novel coronavirus. See HHS Office of the Assistance
Secretary for Preparedness and Response, Determination of the HHS Secretary that a Public Health Emergency
Exists, available at https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx
. On April 21,
2020, the HHS Secretary renewed the COVID-19 public health emergency declaration, effective April 26, 2020. See
HHS Office of the Assistance Secretary for Preparedness and Response, Renewal of Determination That A Public
Health Emergency Exists, available at
https://www.phe.gov/emergency/news/healthactions/phe/Pages/covid19-
21apr2020.aspx. The Secretary may extend the public health emergency declaration for subsequent 90-day periods
for as long as the public health emergency continues to exist, and may terminate the declaration whenever he
determines that the public health emergency has ceased to exist.
6
Medical management includes medical necessity review (including concurrent review) and step-therapy
approaches, among other techniques.
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Pub. L. No. 116-136 (2020).
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References in this document to section 6001 of the FFCRA should be considered to include the amendments made
to section 6001 by section 3201 of the CARES Act, unless otherwise specified.