Learn more about the Current Status of the Federal Vaccine Mandate and the Coverage of OTC Covid-19 Tests Required:
CURRENT STATUS OF THE FEDERAL VACCINE MANDATES
A number of federal vaccine requirements
have been imposed, all of which have faced
various legal challenges. Highlighted below
are two federal vaccine requirements and
their current legal statuses.
On Jan. 7, 2022, the U.S. Supreme Court
heard oral arguments on two federal
vaccine requirements: OSHA’s emergency
temporary standard (ETS) and the Centers
for Medicare & Medicaid Services (CMS)
emergency rule requiring COVID-19
vaccination of certain health care workers.
OSHA ETS
The ETS established a vaccination-or-testing
requirement for private employers with 100
or more employees. These employers were
to require employees to be fully vaccinated
against COVID-19 or be tested on a weekly
basis and wear face coverings at work.
On Jan. 13, 2022, the Supreme Court stayed
the OSHA ETS, ruling that OSHA was not
given the power to regulate public health
more broadly than occupational dangers.
Given this ruling, employers are not
required to comply with OSHA’s ETS at this
time. On Jan. 25, 2022, OSHA withdrew its
COVID-19 ETS. However, the agency stated
that it will continue to pursue the
regulation as a proposed permanent rule.
CMS Rule for Health Care Workers
The CMS rule requires Medicare- and
Medicaid-certified providers and suppliers
to establish a policy requiring covered staff
members to be vaccinated against COVID19 unless they are eligible for an exemption
based on recognized medical conditions or
religious beliefs.
On Jan. 13, 2022, the Supreme Court
dissolved the temporary injunctions
blocking enforcement of the CMS
emergency rule. As a result, the emergency
rule has been reinstated and is now being
enforced. CMS has issued guidance on the
rule for various state groups (QSO-22-07-
ALL, QSO-22-09-ALL and QSO-22-11-ALL).
COVERAGE OF OTC COVID-19 TESTS REQUIRED
On Jan. 10, 2022, the Depts. of Labor (DOL),
Health and Human Services (HHS), and the
Treasury issued FAQ guidance regarding the
requirements for group health plans and
health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.
Legal Requirements
Plans and issuers must cover the costs of
COVID-19 tests during the COVID-19 public
health emergency without imposing cost sharing requirements, prior authorization or
other medical management requirements.
As of Jan. 15, 2022, the cost of these tests
must be covered, even if they are obtained
without the involvement of a health care
provider. However, the FAQs do not require
tests to be covered if they are not for
individualized diagnosis (such as tests for
employment purposes).
Plan Options
Plans and insurance issuers may place some
limits on coverage, such as:
• Requiring individuals to purchase a test
and submit a claim for reimbursement.
• Providing direct coverage through
pharmacy networks or direct-to-consumer shipping programs.
• Limiting the number or frequency of OTC
COVID-19 tests that are covered.
• Taking steps to prevent, detect and
address fraud and abuse.
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