MDS Alert

Question: As the pandemic becomes the new normal, which entity is supposed to cover the cost of testing residents who are Medicare beneficiaries for COVID-19?

Texas Subscriber

Answer: Beginning July 6, 2020, and for the duration of the public health emergency (PHE), Original Medicare and Medicare Advantage plans will cover diagnostic COVID-19 lab tests. Nondiagnostic tests will not be covered, per a recent MLN Matters bulletin, “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19).” The changes were released by the Centers for Medicare & Medicaid Services (CMS) in response to updated Centers for Disease Control and Prevention (CDC) guidelines for testing residents and healthcare personnel in nursing homes.

The MLN Matters article lists these situations, though doesn’t specify whether CMS considers them to be diagnostic. The CDC specifies that effective and efficient testing in nursing homes is a crucial addition to regular infection control and prevention measures for keeping COVID-19 infections out of nursing facilities or detecting and controlling transmission before an outbreak occurs. The situations listed by MLN Matters are:

• Viral testing of residents for SARS-CoV-2;
• Initial viral testing in response to an outbreak;
• Recommended testing to determine resolution of infection with SARS-CoV-2; and
• Public health surveillance for SARS-CoV-2.