Murphy moves to waive all consumer cost sharing for medically necessary COVID-19 testing

Gov. Phil Murphy, in an effort to support consumer access to COVID-19 testing and testingrelated services, announced Tuesday efforts to waive consumer cost sharing for all medically necessary coronavirus testing, as well as services related to testing.

The effort was part of administrative actions from the Department of Banking & Insurance, Department of Human Services, Department of Health and Department of the Treasury.

This waiver includes emergency room, urgent care and office visits related to COVID-19 testing for the state’s individual, small and large group markets; the State Health Benefits Program and School Employees’ Health Benefits Program; NJ FamilyCare’s CHIP population; and the state’s uninsured population, eligible for the charity care program.

With the understanding that many residents rely on employer-sponsored coverage, the governor also encouraged employers to consider measures to support consumer access to medically necessary COVID-19 screening, testing and testing-related services, including waiving cost sharing where appropriate.

The administration’s actions also increase access to telehealth services, prescription medications supply and outreach to high risk populations.

“As we continue to strengthen our efforts to mitigate the spread of COVID-19, we must ensure that our residents are focused on their health and not on the cost of medically necessary testing,” Murphy said. “These actions bolster our state’s coordinated response and preparedness efforts by eliminating affordability concerns for New Jerseyans.”

A look at the administrative actions, as provided by the Governor’s Office:

Department of Banking & Insurance bulletin to all carriers in the individual, small and large group markets:

  • Advises carriers to waive all cost sharing for emergency room (in or out of network), urgent care (in network) and office visits (in network) associated with medically necessary screening and testing (in and out of network laboratories) for COVID-19.
  • Advises carriers to: keep consumers informed about the waiving of cost sharing and how to access care as necessary; ensure provider networks are adequately prepared to handle a potential increase in need for health services; make timely utilization management determinations; develop robust telehealth programs with providers as appropriate; cover costs of immunization if a vaccine becomes available; expand access to prescription drugs to provide coverage for drugs to treat COVID-19 at a preferred level of cost sharing.

Department of Human Services directive for NJ FamilyCare (Medicaid and CHIP):

  • Directs NJ FamilyCare, the state’s Medicaid program, to cover testing, visits for testing and testing-related services without cost to members.
  • Directs the waiving of COVID-19 testing, visits for testing and testing-related services in the Children’s Health Insurance Program.
  • The NJ FamilyCare program will also cover 90-day supplies of prescriptions for maintenance medications, will encourage providers to use telehealth for routine visits when telehealth options are available, will mobilize health plan care managers statewide to ensure that people who are at high risk due to medical conditions or disability receive the services and support they need.
  • Directs hospitals to waive cost sharing for uninsured individuals who are eligible for charity care for medically necessary testing and testing-related services for the COVID-19 virus.

Department of Health bulletin for acute care hospitals for the charity care program:

  • Advises hospitals to refrain from imposing cost sharing for uninsured individuals eligible for charity care, for any visit to the hospital, when the purpose of the visit is to be tested for COVID-19.
  • Advises hospitals to waive any cost-sharing for COVID-19 laboratory tests for uninsured individuals eligible for charity care.

New Jersey Division of Pension and Benefits for SHBP/SEHBP action:

  • Advises that for the SHBP and SEHBP, all cost sharing for emergency room (in or out of network hospitals), urgent care (in network) or provider office visits (in network) associated with medically necessary testing for COVID-19 are to be waived.
  • Directs the Pharmacy Benefit Manager to lessen restrictions on early refill for prescriptions on maintenance medications so that individuals have access to medically necessary medications without waiting until the end of prescription cycle.
  • Directs the Third-Party Administrator for the SHBP and SEHBP to inform beneficiaries about the availability of telemedicine and telehealth services.