Testing is vital in alleviating the spread of COVID-19. The Center for Disease Control and Prevention recommended that Americans use the at-home test kits if they begin to show symptoms at least five days after contact with an infected person. As COVID-19 cases continue to surge in the United States due to the new Omicron variant, the Joe Biden Administration stepped up efforts to increase testing capacity starting January 15th, 2022. The administration allowed households to order about four free at-home test kits from COVID tests.gov, increasing the number of COVID-19 tests available in schools and community health centers.
Also, the Biden administration required private insurers to cover at-home test kits costs. Starting January 15th, 2022, insurance companies should reimburse for at-home tests purchased out of pocket by their members (The White House, 2022). This report will, however, focus on understanding how the emergency rule applies to the State of New York.
Covid-19 Test Reimbursements in the State of New York
Effective December 13th, 2021, New York issued guidance confirming Medicaid will cover FDA-authorized at-home test kits purchased or ordered by Medicaid enrolled practitioners. The policy requires that the Over-the-counter FDA-approved kits be used following the CDC recommendations for antigen detection. The policy applies to Medicaid Managed Care and Medicaid fee for service (FFS).
The at-home test kits covered under the New York System (NYS) Medicaid policy must be authorized by FDA for use in both asymptomatic and symptomatic patients. Self-collection without medical observation is also allowed. A fiscal order for OTC tests made by a Medicaid- enrolled member is required. For every budgetary order, only one test kit with no refills can be ordered per week.
Under the NYS Medicaid FFS coverage, the at-home COVID-19 test kits eligible for coverage include QuickVue AT-Home COVID-19 Test, BinaxNOW COVID-19 Antigen Self-Test, CareStart COVID-19 Antigen Home Test, and InteliSwab COVID-19 Rapid Test.
Pharmacies can bill for COVID-19 test kits using the National Drug Code provided. The NDC is derived by using Universal Product Code. The amount indicated on the NYS Medicaid Pharmacy List of Reimbursement Drugs is up to $25 per test kit. However, the reimbursement for each test kit will be lower than indicated. When submitting pharmacy claims for OTC items, pharmacies must provide a Usual and Customary price (NYS, 2021).
UnitedHealthcare
The New York Medicaid Managed Care plan is offered through the UnitedHealthcare Community Plan. UnitedHealthcare argued that it would cover at-home COVID-19 test kits with no member sharing cost. To qualify for coverage, the at-home test kits must be FDA-authorized, a fiscal order by a practitioner is required, and one test kit per order per week is to be purchased.
The State Children’s Health Insurance Program (CHIP) must cover the rapid tests without cost-sharing. Also, patients with Medicare advantage plans should check with their plan as it may offer coverage and payment for over-the-counter COVID-19 tests.
Members can submit a receipt for reimbursement online through myuhc.com or submit a receipt through a reimbursement form. The maximum amount that one can be reimbursed is $12 per kit (UHC, 2021).
Highmark Blue Cross Blue Shield of Western New York (BCBSWNY)
According to federal regulations, private insurers must pay for up to eight COVID-19 at-home test kits per person per month. Insurers like Blue Cross Blue Shield of Western New York have been paying for lab-processed PCR tests ordered by healthcare providers. In addition, now individuals can get coverage for at-home COVID-19 test kits without a prescription.
However, the insurers can only cover at-home tests for individual use. This means that if one wants to take the at-home test for travel reasons or because an employer ordered the tests are not covered under the Highmark BCBS of Western New York.
Just as the federal government announced, individual members can now seek reimbursement when they purchase the over-the-counter tests from January 15th, 2022, through April 16th, 2022. The tests must be FDA-approved, and only eight test kits will be reimbursed per member per month.
Under the Highmark BCBS of Western New York, federal employees plan members and self-insured ASO individuals are fully insured and are eligible for reimbursement. In addition, Highmark BCBSWNY Medicare Advantage members can be reimbursed as long as an authorized healthcare provider performs the tests.
For one to get reimbursed, you must complete the subscriber claim form. The form is located on the members’ form page. Each individual must submit their claim form as tests for multiple members cannot be combined in one form. During submission, one must include a copy of their receipt and the barcode label from the test kit package (Highmark BCBSWNY, 2022).
The center for disease and drug control encourages individuals to get tested if they experience a symptom of what could be COVID-19, have been exposed to someone who tested positive, and if they gather indoors with persons who have not been vaccinated.
Most test kits can be ordered online through COVIDTests.gov, especially those without insurance coverage (Zremski, 2022).
Summary
In New York, effective December 13th, 2021, issued guidance requiring Medicaid to cover FDA-approved at-home COVID-19 test kits. The test kits must be used per the CDC recommendation. The policy requires that members can order about four free tests. The Medicaid-managed care plan in New York is provided through the UnitedHealthcare community plan. Other insurers that offer coverage include BCBSWNY, CHIP, and Medicare Advantage plans. The at-home tests to be reimbursed under the mentioned plans include QuickVue AT-Home COVID-19 Test, BinaxNOW COVID-19 Antigen Self-Test, CareStart COVID-19 Antigen Home Test, and InteliSwab COVID-19 Rapid Test. The maximum amount to be reimbursed by private insurers is $12 per month per individual. However, under the NYS Medicaid FFS, pharmacies can bill up to $25. The number of tests that are covered in eight tests per member. Those with no insurance plan can always order a free test or get tested at community health clinics. Members requiring reimbursement can submit the claim form online or hardcopy. A receipt must be attached, and each member will submit their claim forms.
References
Highmark BCBSWNY. (2022). Information Regarding Coronavirus (COVID-19) | Highmark BCBSWNY. https://www.bcbswny.com/. Retrieved January 27th, 2022, from https://www.bcbswny.com/content/wny/about/news/coronavirus.html.
NYS. (2021). New York State (NYS) Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage As of 12/28/2021. Health.ny.gov. Retrieved January 27th, 2022, from
The White House. (2022). Fact Sheet: The Biden Administration to Begin Distributing At-Home, Rapid COVID-19 Tests to Americans for Free | The White House. The White House. Retrieved January 27th, 2022, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/01/14/fact-sheet-the-biden-administration-to-begin-distributing-at-home-rapid-COVID-19-tests-to-americans-for-free/.
UHC. (2021). Over-the-counter at-home COVID-19 tests. Uhc.com. Retrieved January 27th, 2022, from https://www.uhc.com/health-and-wellness/health-topics/COVID-19/coverage-and-resources/COVID-19-at-home-testing-coverage#uhccp.
Zremski, J. (2022). At-home COVID-19 tests: Here’s how to get them for free. Buffalo News. Retrieved January 27th, 2022, from https://buffalonews.com/news/local/at-home-COVID-19-tests-heres-how-to-get-them-for-free/article_ea4503d8-7577-11ec-a474-5b19f754dfee.html
