Price Transparency: Requirements for Providers to Make Public Cash Prices for COVID-19 Diagnostic Testing (CMS)
Summary
A question-and-answer document on the price transparency requirement in section 3202(b) of the CARES Act, enacted on March 27, 2020, which requires providers of COVID-19 diagnostic tests to post the cash price of a test on their public internet website. The requirement took effect on enactment and lasts for the duration of the COVID-19 public health emergency declared under section 319 of the Public Health Service Act. The document ties it to section 6001 of the Families First Coronavirus Response Act, enacted March 18, 2020, under which group health plans and insurers must cover COVID-19 diagnostic testing without cost-sharing, prior authorization or other medical management requirements, and to section 3202(a) of the CARES Act, under which plans and issuers reimburse a provider the negotiated rate or, without one, the cash price listed on its website.
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Full text
Price Transparency: Requirements for Providers to Make Public Cash Prices for
COVID-19 Diagnostic Testing
1. Question: What price transparency requirement was passed in the Coronavirus Aid, Relief, and
Economic Security Act (CARES) Act?
Answer: The CARES Act was enacted on March 27, 2020. Section 3202(b) of the CARES Act requires
providers of diagnostic tests for COVID-19 to make public the cash price for a COVID-19 diagnostic test
on the provider’s public internet website.
2. Question: For how long is this price transparency requirement in effect?
Answer: The requirement enacted in section 3202(b) of the CARES Act is effective upon enactment of
the CARES Act and continues in effect for the duration of the COVID-19 public health emergency (PHE)
declared under section 319 of the Public Health Service Act (PHS Act). For more information about PHE
declarations and timing, please refer to HHS’ Public Health Emergency Q&As.
3. Question: How does the price transparency requirement to post the cash price of COVID-19
diagnostic testing relate to other provisions in the CARES Act and the Families First Coronavirus
Response Act (FFCRA)?
Answer: The FFCRA was enacted on March 18, 2020. Section 6001 of the FFCRA generally requires group
health plans and health insurance issuers offering group or individual health insurance coverage to
provide benefits for certain items and services related to diagnostic testing for the detection of SARS-
CoV-2 or the diagnosis of COVID-19 (referred to collectively in this document as COVID-19) when those
items or services are furnished on or after March 18, 2020, and during the applicable emergency period.
Under the FFCRA, plans and issuers must provide this coverage without imposing any cost-sharing
requirements (including deductibles, copayments, and coinsurance) or prior authorization or other
medical management requirements.
Section 3201 of the CARES Act amended section 6001 of the FFCRA to include a broader range of
diagnostic items and services for the detection of SARS-CoV-2 or the diagnosis of COVID-19 that plans
and issuers must cover without any cost-sharing requirements, prior authorization, or other medical
management requirements. Additionally, section 3202(a) of the CARES Act generally requires plans and
issuers providing coverage for the items and services described in section 6001(a) of the FFCRA to
reimburse any provider of COVID-19 diagnostic testing an amount that equals the negotiated rate or, if
the plan or issuer does not have a negotiated rate with the provider, the cash price for such service that
is listed by the provider on its public website. The plan or issuer may negotiate a rate with the provider
that is lower than the cash price. More information about the FFCRA can be found in FAQs About
Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act
Implementation Part 42.
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