NJ governor waives state health plan copays, cost-sharing for coronavirus testing (updated)

Governor Phil Murphy today announced that the state will waive co-pays and cost-sharing for testing related to the coronavirus for state health plans, state workers and public school employees, Medicaid program participants, and uninsured residents who are eligible for charity care. The waiver includes emergency room, urgent care, and office visits related to COVID-19 testing.

The governor is also encouraging employers to consider measures to support consumer access to medically necessary COVID-19 screening, testing, and testing-related services, including waiving cost-sharing.

The state is also increasing access to telehealth services, prescription medication supplies, and outreach to high-risk populations.

“As we continue to strengthen our efforts to mitigate the spread of COVID-19, we must ensure that our residents are focused on their health and not on the cost of medically necessary testing,” Murphy said. “These actions bolster our state’s coordinated response and preparedness efforts by eliminating affordability concerns for New Jerseyans.”

The changes were made through administrative actions of the state’s Department of Banking and Insurance, Department of Human Services, Department of Health, and Department of the Treasury.

“Eliminating potential barriers to testing for residents is an important part of our state’s response effort and our work to prevent the spread of the novel coronavirus in our state,” said Department of Banking and Insurance Commissioner Marlene Caride. “To ensure that cost does not prohibit residents from receiving medically necessary testing and screening, the department is advising carriers to immediately take action to waive cost-sharing. This is a proactive measure to ensure we have protections in place to contain the infection and keep residents safe.”

The Department of Health, in coordination with the Department of Human Services, has instructed hospitals to eliminate consumer cost-sharing associated with testing and testing-related services for COVID-19 for individuals who are eligible for charity care, said Health Commissioner Judith Persichilli.  

Administrative actions

Department of Banking and Insurance bulletin to all carriers in the individual, small and large group markets:

• Advises carriers to waive all cost-sharing for emergency room (in or out of network), urgent care (in-network), and office visits (in-network) associated with medically necessary screening and testing (in and out of network laboratories) for COVID-19.
• Advises carriers to: keep consumers informed about the waiving of cost-sharing and how to access care as necessary; ensure provider networks are adequately prepared to handle a potential increase in need for health services; make timely utilization management determinations; develop robust telehealth programs with providers as appropriate; cover costs of immunization if a vaccine becomes available; expand access to prescription drugs to provide coverage for drugs to treat COVID-19 at a preferred level of cost-sharing. 

Department of Human Services Directive for NJFamilyCare (Medicaid and CHIP):

• Directs NJ FamilyCare, the state’s Medicaid program, to cover testing, visits for testing, and testing-related services without cost to members. 
• Directs the waiving of COVID-19 testing, visits for testing, and testing-related services in the Children’s Health Insurance Program (CHIP).
• The NJ FamilyCare program will also cover 90-day supplies of prescriptions for maintenance medications, will encourage providers to use telehealth for routine visits when telehealth options are available, will mobilize health plan care managers statewide to ensure that people who are at high risk due to medical conditions or disability receive the services and support they need. 
• Directs hospitals to waive cost-sharing for uninsured individuals who are eligible for charity care for medically necessary testing and testing-related services for the COVID-19 virus.

Department of Health Bulletin for Acute Care Hospitals for the Charity Care Program:

• Advises hospitals to refrain from imposing cost-sharing for uninsured individuals eligible for charity care, for any visit to the hospital, when the purpose of the visit is to be tested for COVID-19. 
• Advises hospitals to waive any cost-sharing for COVID-19 laboratory tests for uninsured individuals eligible for charity care.

New Jersey Division of Pension and Benefits for SHBP/SEHBP Action:

• Advises that for the SHBP and SEHBP, all cost-sharing for emergency room (in or out of network hospitals), urgent care (in-network), or provider office visits (in-network) associated with medically necessary testing for COVID-19 are to be waived.
• Directs the pharmacy benefit manager to lessen restrictions on early refill for Rx on maintenance medications so that individuals have access to medically necessary medications without waiting until the end of the prescription cycle.
• Directs the third-party administrator for the SHBP and SEHBP to inform beneficiaries about the availability of telemedicine and telehealth services

Tuesday afternoon, state officials also announced guidelines for state employees from the New Jersey Civil Service Commission.

“The health and safety of our employees is our number one concern,” said Governor Murphy. “The guidelines we are issuing today, following the declaration of a state of emergency in New Jersey, are designed to limit the exposure of state employees to COVID-19 and to protect the general public. These guidelines will allow our state workforce to continue carrying out the day to day business of running our state while providing necessary public health accommodations.” 

Employees at state agencies who are diagnosed with COVID-19 should stay home and do not need to use accumulated sick leave. Employees who have been exposed to the virus, and are thus either required to self-quarantine or recommended to stay home, can do so without using accumulated sick leave. Employees can stay home without using allocated sick leave in the event of the closing of their child’s school or child care center.

State agencies can implement work-from-home policies and flexible scheduling and temporarily re-designate employee assignments and responsibilities as needed, officials said.