CMS Provides COVID-19 Guidance for Nonfederal Governmental Health Plans

On June 5, 2020, CMS issued a letter providing COVID-19 guidance related to nonfederal governmental plan sponsors in light of the continued public health emergency. Highlights include:

  • COVID-19 Related Coverage. CMS reiterates that nonfederal governmental plans are group health plans subject to the requirements under the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which includes the requirement to provide benefits related to COVID-19 testing without cost sharing or prior authorization requirements. In addition, CMS encourages all nonfederal governmental plans to offer services related to COVID-19 treatment without cost sharing or prior authorization.
  • Certain Extended Timeframes. CMS agrees with the relief provided by the DOL and IRS regarding the relaxed enforcement of certain timeframes related to group health plans (see previous Compliance Corner articles "Extension of Certain Timeframes for Employee Benefit Plans, Participants and Beneficiaries" and "DOL Announces Relief for Certain ERISA Deadlines" for additional information). To that end, CMS will adopt a similar policy for nonfederal governmental group health plans that will disregard the outbreak period (defined as March 1, 2020, through 60 days after the end of the COVID-19 National Emergency) for similar time frames applicable to nonfederal governmental group health plans. Importantly, unlike plans subject to the DOL and IRS notices, CMS does not require nonfederal governmental plans to provide such relief. Rather, CMS has simply encouraged the extensions and provided enforcement relief for plans that voluntarily comply.
  • Expanding Access to Telehealth and Prescription Drugs. CMS strongly encourages all nonfederal governmental plans to expand and promote telehealth services by notifying participants of its availability, ensuring access to robust telehealth services (such as mental health and substance use disorder services), and covering telehealth services without cost sharing (or other medical management requirements). In addition, CMS encourages nonfederal governmental plans that provide prescription drug benefits to disregard any fill restrictions when appropriate.
  • Mid-Year Changes. CMS has encouraged any applicable state and local authorities to not take enforcement action against plans that make mid-year changes to provide greater coverage for telehealth or for diagnosis and treatment of COVID-19, or to reduce (or eliminate) cost sharing requirements for such services. Should plans choose to make these changes, CMS encourages prompt employee communication. Further, CMS will not take enforcement action against any plan that makes such changes without the 60-day advance notice required by the PHS Act and final rules regarding Summary of Benefits and Coverage.

Sponsors of nonfederal governmental plans should be aware of the letter’s guidance, and note that while some COVID-19 relief is required, some is merely encouraged. For any subsequent guidance related to COVID-19, CMS encourages plan sponsors to monitor the Center for Consumer Information and Insurance Oversight’s website.

CMS Letter to Nonfederal Governmental Plans »
Center for Consumer Information and Insurance Oversight COVID-19 Guidance »