Medicare Coverage of COVID-19 Diagnostic Testing in Nursing Homes

Client Alert

Gibbons Special Alert

June 29, 2020

The Centers for Medicare & Medicaid Services (“CMS”) announced on June 19, 2020, that claims for COVID-19 diagnostic testing for Medicare beneficiaries who reside in or are patients of nursing homes would be covered by Medicare. This applies to traditional fee-for-service Medicare and Medicare Advantage plans. Beginning on July 6, 2020, through the end of the Coronavirus Public Health Emergency, diagnostic COVID-19 lab tests will be covered for these individuals. The announcement clarified that non-diagnostic tests would not be covered.

This coverage decision follows recently issued CDC Testing Guidelines for Nursing Homes, which highlight the high risk that nursing home residents face for infection, serious illness, and death from COVID-19. The CDC recommends that the COVID-19 diagnostic testing should be performed in addition to other infection prevention and control measures, and turnaround time should be less than 48 hours.

The CDC guidance provides that every nursing home resident should be initially tested and, at least daily, all residents should have their temperatures taken and should be asked about COVID-19 symptoms. Individuals who report signs or symptoms should again be tested.

In a nursing home outbreak, the CDC recommends expanded testing of all residents and healthcare professionals. The CDC defines an outbreak as a single new COVID-19 case in any healthcare professional or a nursing home onset infection in a resident. Following an outbreak, the CDC recommends repeated testing of any resident who leaves and returns to the nursing home or who has known exposure to a COVID-19 case. The repeated testing should occur every seven to ten days, until no new cases are revealed for a period of 14 days since the most recent positive test, and should be coordinated with local governmental health authorities.