on October 8eIn 2021, California Governor Gavin Newsom signed Senate Act No. 510, which requires health plan contracts and disability insurance contracts that provide coverage for hospital, medical, or surgical benefits to cover all COVID-19 testing and vaccinations without cost-sharing or Prior permission. The new law goes beyond COVID-19 and paves the way for testing and vaccination coverage for future pandemics. The law specifically provides coverage for:
Any evidence-based article, service, or immunization intended to prevent or reduce disease, as recommended by the United States Preventive Services Task Force (Task Force).
A health care service or product related to diagnostic and screening tests for a disease that is approved or for which emergency use has been granted by the federal Food and Drug Administration, or recommended by the State Department of Public Health or the Centers for Disease Control and Prevention ( CDC).
Both must be covered no later than 15 business days from the date the Task Force or CDC makes a recommendation regarding the item, service, or immunization.
These requirements apply whether they are provided by an on-network or off-network provider. However, for out-of-network providers, the requirements are limited to the duration of the federal public health emergency.
The bill is retroactive to March 4, 2020, the date the governor declared a state of emergency over the COVID-19 pandemic, and it’s not clear whether plans and providers are expected to reimburse amounts already paid by patients who have been tested. As with most surprising billing laws, the language allows providers in the network to negotiate rates with subscriptions, while rates outside the network remain vague. Out-of-network providers without specifically negotiated rates must be remunerated in the “amount that is reasonable, as determined by reference to prevailing market rates.”
© 2021 Foley & Lardner LLPNational Law Review, Volume XI, Number 313