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PA Bulletin, Doc. No. 21-349



Notice Regarding Coronavirus (COVID-19) Insurance Coverage; Notice 2021-03

[51 Pa.B. 1292]
[Saturday, March 6, 2021]

 The Insurance Department (Department) is issuing this Bulletin to assist individuals and entities regulated by the Department addressing health insurance related services that may arise in the context of the ongoing novel coronavirus (COVID-19) pandemic. All health insurers, other insurance industry representatives and other interested parties are encouraged to review the latest Commonwealth information about COVID-19 released by the Department of Health at

 Effective January 21, 2021, the Federal public health emergency (PHE) was extended for an additional 90 days, and subsequent extensions are anticipated, likely to continue through all of 2021. See January 22, 2021 HHS Message to Governors. Recognizing the critical role that health insurance coverage plays in the public's actual and perceived access to and affordability of health care services, the Department urges health insurers providing coverage to residents in this Commonwealth to continue exercising flexibility to make both COVID-related services and non-COVID-related services available to enrollees.

 The Department particularly draws attention to the following:

 1. Testing for COVID-19. It is expected that insurers will continue to cover testing without cost-sharing as required under The Families First Coronavirus Response Act of 2020 (Pub.L. 116-127) (FFCRA) and Coronavirus Aid, Relief, and Economic Security Act (P.L. 116-136) (CARES Act). As explained in the law and guidance, testing must be covered at no cost throughout the Federal PHE when an ''attending provider'' [described in the tri-agency FAQs Part 43 issued on June 23, 2020 as ''an individual who is licensed (or otherwise authorized) under applicable law, who is acting within the scope of the provider's license (or authorization), and who is responsible for providing care to the patient''] makes an ''individualized clinical assessment to determine whether the test is medically appropriate for the individual in accordance with current accepted standards of medical practice.'' See at Q.3. The Department urges insurers to be alert for any additional guidance that may be issued by the Federal agencies. See Executive Order 13996 of January 21, 2021, ''Establishing the COVID-19 Pandemic Testing Board and Ensuring a Sustainable Public Health Workforce for COVID-19 and Other Biological Threats,'' Sec. 3(a)(ii), 86 FR 7197—7199 (January 21, 2021) (directing the Departments of Treasury, Health and Human Services, and Labor to ''clarify group health plans' and health insurance issuers' obligations to provide coverage for COVID-19 testing.'').

 2. Vaccine for COVID-19. It is expected that insurers will continue to cover vaccinations without cost-sharing and without consideration of the network status of the provider, as required under the CARES Act and further explained in the ''Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency'' Interim Final Rule with Request for Comments, 85 FR 71142 (November 6, 2020) et seq. (IFC). Additionally, the Department urges insurers to expeditiously work through any administrative or billing issues that may arise with respect to administration of vaccines by pharmacists.

 3. Telehealth Delivery of Services. In Notice 2020-03, 50 Pa.B. 1788 (March 21, 2020), the Department encouraged health insurers to review their respective participating telehealth service provider arrangements, provide coverage of costs related to telehealth services and to be prepared to meet any increased demand for that means of delivery, given that COVID-19 is a communicable disease and therefore some insureds may prefer to use telehealth services instead of in-person health care services. The Department appreciates many health insurers' efforts to implement telehealth flexibilities, including those that were made a permanent part of the insurers' business operations, as well as insurer efforts to reimburse for telehealth visits in the same manner as they would for in-person appointments during the public health emergency. However, health insurers have taken different approaches both in the telehealth policy flexibilities implemented as well as the duration of such flexibilities. Unfortunately, this has caused both provider and consumer confusion. Therefore, the Department encourages health insurers to implement broader consistency across their telehealth flexibility policies, including consideration of, for example:

 • Best practices for care management, including continuity of care as between telehealth and in-person care.

 • Network flexibility for providers that offer both telehealth and in-person services.

 • Language consistency and clarity so that providers and patients can easily understand the timing and substance of any changes in telehealth policies.

 • 60 days' advance notice to providers and patients of any change in policy.

 The Department also strongly encourages health insurers to extend such flexibilities through the end of the Federal PHE or the Commonwealth PHE, whichever occurs later, and to implement a 60-day wind-down period for an orderly transition for both patients and providers to adjust to a post-PHE environment, as contemplated by the Federal Administration. See January 22, 2021 HHS Message to Governors.

 4. Balance Billing and Surprise Balance Bills. Health insurers are urged to assist insureds in accessing in-network or publicly funded health services to avoid balance billing and surprise balance bills. Taking steps now to effectuate processes as contemplated by the No Surprises Act is encouraged. See Consolidated Appropriations Act of 2021, Div. BB, Title I (P.L. 116-260, 134 Stat. 1182) (December 27, 2020). With respect to COVID testing and vaccines, we expect that health insurers already have in place mechanisms to avoid balance billing. See FFCRA section 6001, as amended by section 3201 of the CARES Act, CARES Act section 3202, and FAQs about FFRCA and CARES Act Implementation Part 43 (no balance billing for testing during PHE); Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency, Interim Final Rule with Request for Comments, 85 FR 71142 (November 6, 2020) et seq. (amending 45 CFR 147.130 (relating to coverage of preventive health services)) (no balance billing for vaccine during PHE).

 5. Coordination with Self-Funded Business. While not under the Department's regulatory jurisdiction, the Department continues to encourage health insurers to coordinate closely with the business they administer on behalf of employers who self-fund their health benefits to ensure consistency in access across all forms of coverage.

 The Department extends its appreciation to health insurers in working with the Commonwealth as all continue to address this public health challenge. Since the COVID-19 situation continues to evolve, health insurers should continually assess their readiness and be prepared to make any necessary adjustments.

 Health insurers and other regulated individuals and entities are advised to contact the Office of the Commissioner, Insurance Department, 1326 Strawberry Square, Harrisburg, PA 17120, with any questions regarding this Bulletin.

Insurance Commissioner

[Pa.B. Doc. No. 21-349. Filed for public inspection March 5, 2021, 9:00 a.m.]

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