Nursing home operators and insurers are butting heads over who should pick up the tab for COVID-19 employee testing.
Some state health officials have deemed the tests medically necessary, meaning they should be covered by insurers under the CARES Act.
“What we’re seeing in New York is that most commercial insurers are refusing to cover those costs. We’re also seeing situations where union health plans are not covering the costs,” said Stephen Hanse, president and CEO of the New York State Health Facilities Association/NYS Center for Assisted Living. “For those providers who are self-insured, the CARES Act doesn’t provide any coverage for them. So, really it’s a significant cost issue.”
Nationwide, the American Health Care Association estimated the cost of one-time testing of all nursing home residents and staff to be $440 million.
Trade groups have called on the federal government to release “clear guidance” on paying for tests. But as of mid-June, there was no resolution — and still a patchwork of approaches and test frequency was emerging across the country.
In Pennsylvania, which has the nation’s sixth-highest staffing numbers, Gov. Tom Wolf (D) initially ordered facilities to test all staff and residents weekly. His administration quickly backed off the mandate, instead calling for baseline testing and follow-ups only in facilities where new cases emerged.
“In initial attempts to comply with the order, providers have already received significant pushback from insurance companies who are unwilling to cover the costs of testing asymptomatic staff — even with a state mandate — because the test is not considered ‘medically necessary,’” said Zach Shamberg, president and CEO of the Pennsylvania Health Care Association.
From the July/August 2020 Issue of McKnight's Long-Term Care News
