October 8e, 2021, California Governor Gavin Newsom enacted Senate Bill 510, which requires health care plan contracts and disability insurance policies that cover hospital, medical, or surgical benefits. cover all COVID-19 tests and vaccinations without cost sharing or prior authorization requirements. The new law goes beyond COVID-19, paving the way for testing and vaccination coverage for future pandemics as well. The law specifically provides coverage for:
- Any evidence-based item, service, or vaccination intended to prevent or mitigate disease, as recommended by the United States Preventive Services Task Force (Task Force).
- A health care service or product related to diagnostic testing and screening for a disease that is approved or granted emergency use authorization by the Federal Food and Drug Administration, or is recommended by the Department of State Public Health or the Centers for Disease Control and Prevention (CDC).
Both must be covered no later than 15 business days after the date the task force or CDC makes a recommendation regarding the item, service, or immunization.
These requirements apply whether they are provided by an on-network or off-network provider. However, for off-grid providers, the requirements are limited to the duration of the federal public health emergency.
The bill is retroactive to March 4, 2020, when the governor declared a state of emergency due to the COVID-19 pandemic, and it is not clear whether plans and providers should reimburse them. amounts already paid by patients who have undergone tests. . As with most surprise billing laws, the language allows network providers to negotiate rates with packages, while leaving off-network rates more murky. Off-grid providers without specifically negotiated rates must be reimbursed the “reasonable amount, as determined from prevailing market rates”.