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Brown & Brown — Conference Presentation (January 2022)
28 slides from Brown & Brown's conference presentation, January 2022
Slide 1: This Webinar Will Start Momentarily
This Webinar Will Start Momentarily. Thank you for joining us.
Slide 2: What We Know and Don't Know About the COVID-19 OTC Test Kit Requirement
What We Know and Don’t Know About the COVID-19 OTC Test Kit Requirement January 2022 Presented By: Regulatory and Legislative Strategy Group
Slide 3: Disclaimer
DISCLAIMER Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview o
Slide 4: Presentation Agenda
Presentation 1 Background and FAQ Part 51 Agenda Additional Considerations and Unanswered 2 Questions 3 Industry Implementation 4 Q&A BROWN & BROWN | 4
Slide 5: Background: FFCRA and CARES Act
Background FFCRA AND CARES ACT Section 6001 of the FFCRA • Requires group health plans and health insurance issuers to provide coverage without cost-sharing, prior authorization or other medical management requirements for the following: • In vitro diagnostic products authorized by the FDA for the d
Slide 6: Background: Agency Guidance Under the FFCRA and CARES Act
Background AGENCY GUIDANCE UNDER THE FFCRA AND CARES ACT FAQ Part 43 • Plans and issuers must cover COVID-19 tests intended for at-home testing under section 6001 of the FFCRA • Applies only when test is ordered by attending health care provider after determining test is medically appropriate for in
Slide 7: Background: Timing and Applicability
Background TIMING AND APPLICABILITY Public Health Emergency Plans subject to section 6001 of the FFCRA • Determined by Secretary of HHS pursuant to • Group health plans and health insurance section 319 of the Public Health Service Act (PHS issuers offering group or individual health Act) insurance c
Slide 8: FAQ Part 51
FAQ Part 51 Released January 10, 2022
Slide 9: FAQ Part 51: Key Takeaways
FAQ Part 51 K E Y TA K E AWAY S • Group health plans must cover over-the-counter (OTC) COVID-19 tests under section 6001 of the FFCRA, with or without an order or individualized clinical assessment by an attending health care provider • January 15, 2022 – The date plans and issuers must begin provid
Slide 10: Coverage of OTC COVID-19 Testing
FAQ Part 51 COVERAGE OF OTC COVID-19 TESTING • Coverage applies even without order of individualized clinical assessment issued by health care provider to tests that do not require a health care provider’s order under applicable Food and Drug Administration (FDA) • Applies to OTC COVID-19 tests auth
Slide 11: Direct Coverage Program
FAQ Part 51 DIRECT COVERAGE PROGRAM • Plans and issuers may provide coverage by reimbursing sellers of OTC COVID-19 tests directly – known as “direct coverage” • Use of this method is “strongly encouraged” by the DOL, HHS and Treasury • Direct coverage allows participants, beneficiaries or enrollees
Slide 12: Direct Coverage Safe Harbor
Direct Coverage Safe Harbor FA Q PA R T 5 1 • Applies to direct coverage program that meets the statutory requirements of section 6001(a)(1) of the FFCRA through both its pharmacy network and a direct-to-consumer shipping program • Applies only to OTC COVID-19 tests administered without a health pro
Slide 13: Limited Test Quantity Safe Harbor
Limited Test Quantity Safe Harbor FA Q PA R T 5 1 • Plans and issuers may limit the number of OTC COVID-19 tests covered for each participant, beneficiary or enrollee to no less than eight tests per 30-day period (or per calendar month) • Limit applies on a per-participant/beneficiary/enrollee basis
Slide 14: Fraud and Abuse
Fraud and Abuse FA Q PA R T 5 1 • Plans and issuers may take reasonable action to prevent, detect and address fraud and abuse when providing coverage of OTC COVID-19 tests • Programs that require individuals to “submit multiple documents or involve numerous steps that unduly delay a participant’s, b
Slide 15: Additional Considerations & Unanswered Questions
Additional Considerations & Unanswered Questions
Slide 16: FAQs: Employer Notice Requirements
FAQs FAQ Part 51 does not describe any specific requirement under section 6001 of the FFCRA. Optional notice under FAQ Part 51: • Plans and issuers may provide education and information resources if the resources “make clear that the plan or issuer provides coverage for, including reimbursement of,
Slide 17: FAQs: Summary of Material Modifications
FAQs Possibly. Are plans required to Examples that may trigger requirement to provide SMM: furnish a summary of • If plan has general exclusion for OTC medicines and supplies without a health care provider’s material modifications order that must now cover OTC COVID-19 tests without a health care pr
Slide 18: FAQs: Midyear Employee Contribution Increases
FAQs It’s unclear. General Rule: • Do plan documents give plan sponsor power to amend the plan? • Cost changes may allow participants to make midyear election changes Can plan sponsor of • Does Section 125 cafeteria plan document recognize cost change as a permissible event? • Is the cost change “si
Slide 19: FAQs: Reimbursement Timing
FAQs How quickly must the Specific timeframe not stated. plan reimburse a claim for an OTC COVID-19 CMS encourages health plans to provide prompt reimbursement for claims for at-home tests test? Is there a FAQ Part 51: deadline to submit Reimbursement should be in accordance with the plan or issuer’
Slide 20: FAQs: Direct Coverage Reimbursement Limits
FAQs Can plans and issuers The reimbursement limit described in FAQ Part 51 of $12 or the actual price of the test using a direct (whichever is lower) applies to tests obtained at non-preferred pharmacies or other retailers only coverage program limit when the plan offers a direct coverage option re
Slide 21: FAQs: Direct Coverage Program Requirements
FAQs It is not entirely clear. Must direct coverage FAQ Part 51: program include both “through both its pharmacy network and a direct-to-consumer shipping program…” preferred pharmacies “systems and technology changes necessary to process the plan’s or issuer’s payment to the and direct-to- preferre
Slide 22: FAQs: FSA and HSA Reimbursement
FAQs Yes. Are the costs of at- The cost of home COVID-19 tests is an eligible medical expense that can be paid or reimbursed home COVID-19 tests by health FSAs, HSAs or HRAs. - IRS News Release IR-2021-181 reimbursable under a health FSA or HSA? IRS news release does not specify whether at-home COVI
Slide 23: Industry Implementation
Industry Implementation ea
Slide 24: Administration of Coverage
Administration of Coverage W I L L T E S T S B E C O V E R E D U N D E R P R E S C R I P T I O N D R U G B E N E F I T, M E D I C A L BENEFIT OR BOTH? • Do either/both vendors offer a direct access network and home delivery option? • Do vendors satisfy the safe harbors provided in FAQ Part 51? • Are
Slide 25: Cost Implications – Pharmacy vs. Medical
Cost Implications – Pharmacy vs. Medical • Will there be implementation or per claim fees? • Are vendors incorporating a cap on reimbursement amounts? • Negotiated rates with direct coverage providers • Risk of “double dipping” BROWN & BROWN | 25
Slide 26: Question & Answer
Question & Answer
Slide 27: HRCI and SHRM Credits
HRCI and SHRM Credits Brown & Brown is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP® or SHRM-SCP®. This program is valid for 1 PDCs for the SHRM-CP or SHRM-SCP. Activity ID No. 22-P2Z7G. For more information about certification or recertification, please visit www.
Slide 28: Find your solution at BBrown.com
Find your solution at BBrown.com DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intend
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