Order Extending Coverage of COVID-19 Testing for Symptomatic and Asymptomatic Individuals
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This Commissioner's Order requires health carriers offering plans in the District of Columbia to cover COVID-19 diagnostic testing for individuals meeting District of Columbia Department of Health Administrative Order No. 2020-07 standards, without a provider order or cost-sharing, for the duration of the Public Health Emergency.
Requires carriers to cover COVID-19 diagnostic testing for individuals who meet DC Health Administrative Order No. 2020-07 standards without a provider order or cost sharing.
Clarifies that insurers may, but are not required to, cover employer-required return-to-work testing.
Coverage Criteria for COVID-19 Diagnostic Testing
Covered diagnostic COVID-19 testing per DC Health standards
Covered when ALL of the following are met
No physician or other health care provider order or cost sharing is required when these conditions are met.
Insurers are required to cover diagnostic testing for COVID-19 when the individual meets the standards set forth in District of Columbia Department of Health Administrative Order No. 2020-07. Coverage must be provided without an order of testing by a physician or other health care provider and without cost sharing for the duration of the Public Health Emergency, including any extensions. However, insurers may, but are not required to cover employer‑required return‑to‑work testing (tests that employers require employees to produce a negative result to return to work) except as otherwise provided in the Order.
Coding and Timeframe
| No codes listed |
Provider Requirements, Documentation, and Denial Risks
Prior authorization / provider order waiver
No physician or other health care provider order is required for coverage when the individual meets the DC Health Administrative Order No. 2020-07 standards; carriers must cover testing without a provider order or cost sharing for the duration of the Public Health Emergency.
Provider impact: coverage limited to DC Health standards
This Order applies to health plans issued in the District and requires carriers to cover diagnostic COVID-19 testing for individuals who meet DC Health testing standards during the Public Health Emergency; providers should be aware coverage is limited to those meeting the Order's standards.
Document that DC Health testing standards are met
Providers should document that the individual meets the criteria established in District of Columbia Department of Health Administrative Order No. 2020-07 to support coverage without a physician order or cost sharing.
- Document which DC Health Administrative Order No. 2020-07 criteria the individual meets
- Retain evidence supporting symptomatic or asymptomatic status and any risk-setting information referenced in the DC Health standards
Denial risk if DC Health standards are not met
Coverage applies only for individuals who meet the standards in DC Health Administrative Order No. 2020-07; tests for persons who do not meet those standards may not be covered and could be denied.
Background
SARS‑CoV‑2 is the virus that causes COVID‑19 and can be transmitted by both symptomatic and asymptomatic individuals. Identifying asymptomatic infections can materially inform public health and clinical management decisions; for that reason the Order recognizes testing of certain asymptomatic persons as medically necessary during the Public Health Emergency, and directs coverage for tests that meet the DC Health Administrative Order No. 2020‑07 standards.
Definitions
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