Stop COVID–19 Test Surprise Medical Bills Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 533 To prevent surprise medical bills with respect to COVID–19 testing. IN THE HOUSE OF REPRESENTATIVES JANUARY 28, 2021 Mrs. FLETCHER (for herself, Mrs. AXNE, Ms. ESCOBAR, Ms. GARCIA of Texas, Mr. GRIJALVA, Mr. HASTINGS, Mrs. HAYES, Ms. NORTON, Ms. JACKSON LEE, Mr. JOHNSON of Georgia, Mr. JONES, Mr. LAWSON of Florida, Mr. LEVIN of California, Ms. PORTER, Ms. SCHRIER, Mr. TAKANO, and Ms. VELA´ZQUEZ) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the com- mittee concerned A BILL To prevent surprise medical bills with respect to COVID– 19 testing. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Stop COVID–19 Test 4 Surprise Medical Bills Act of 2021’’. 5 VerDate Sep 11 2014 23:36 Feb 15, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H533.IH H533 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 533 IH SEC. 2. MEDICAL MANAGEMENT. 1 Section 6001 of the Families First Coronavirus Re- 2 sponse Act (Public Law 116–127) is amended by adding 3 at the end the following: 4 ‘‘(e) MEDICAL MANAGEMENT.—For purposes of this 5 section, the term ‘medical management’ includes deter- 6 minations about why an individual sought testing, the na- 7 ture of the clinical assessment that was associated with 8 the testing, whether the individual was showing symptoms, 9 what provider ordered the testing, the frequency of testing 10 obtained by the individual, and other reviews of the en- 11 counters or events that proceeded or followed a service de- 12 scribed in subsection (a). Such term does not include rea- 13 sonable efforts by a group health plan or health insurance 14 issuer to encourage individuals to obtain tests from lower 15 priced providers (provided that such reasonable efforts do 16 not delay or otherwise impede access to testing).’’. 17 SEC. 3. IMPROVEMENTS TO TRANSPARENCY POLICY. 18 (a) IN GENERAL.—Section 3202 of the CARES Act 19 (Public Law 116–136) is amended by adding at the end 20 the following: 21 ‘‘(c) IMPROVEMENTS TO TRANSPARENCY POLICY.— 22 Not later than 30 days after the date of enactment of this 23 subsection, the Secretary of Health and Human Services 24 shall survey a sample of providers of the items and serv- 25 ices described in section 6001(a) of division F of the Fam- 26 VerDate Sep 11 2014 23:36 Feb 15, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H533.IH H533 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 533 IH ilies First Coronavirus Response Act (Public Law 116– 1 127) regarding the cash prices for such items and services 2 as listed by the providers on a public internet website. The 3 Secretary shall survey no fewer than 200 providers rep- 4 resenting a diversity of sizes, geographic locations, test 5 types, and care settings (such as hospitals, laboratories, 6 and free-standing emergency rooms). 7 ‘‘(d) PUBLIC REPORT.—Not later than 45 days after 8 the date of enactment of this subsection, the Secretary of 9 Health and Human Services shall publish a report on cash 10 prices for items and services published under subsection 11 (b)(1), which shall include— 12 ‘‘(1) the compliance rate of providers with the 13 cash price publication requirement under subsection 14 (b)(1); 15 ‘‘(2) the average cash price for each item and 16 service described in section 6001(a) of division F of 17 the Families First Coronavirus Response Act (Public 18 Law 116–127) and published under subsection 19 (b)(1); 20 ‘‘(3) with respect to each such item and service, 21 a comparison of such average cash price to the reim- 22 bursement rate under the Medicare program under 23 title XVIII of the Social Security Act (42 U.S.C. 24 1395 et seq.); and 25 VerDate Sep 11 2014 23:36 Feb 15, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H533.IH H533 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 533 IH ‘‘(4) any outlier cash prices published under 1 subsection (b)(1) (including the names of the pro- 2 viders charging such prices) that substantially ex- 3 ceed the average cash price.’’. 4 SEC. 4. GUIDANCE ON BILLING FOR PROVIDER VISITS AS- 5 SOCIATED WITH COVID–19 TESTING. 6 The Secretary of Health and Human Services, the 7 Secretary of Labor, and the Secretary of the Treasury, 8 shall jointly issue guidance, not later than 30 days after 9 the date of enactment of this Act for purposes of clari- 10 fying— 11 (1) the process for submitting claims for items 12 and services described in section 6001(a) of the 13 Families First Coronavirus Response Act (Public 14 Law 116–127) to ensure that individuals enrolled in 15 individual or group health insurance coverage or 16 group health plans to whom such items and services 17 are furnished are not subject to cost sharing or prior 18 authorization or other medical management require- 19 ments; and 20 (2) that providers should not collect cost-shar- 21 ing amounts from individuals seeking items and 22 services described in section 6001(a) of such Act. 23 Æ VerDate Sep 11 2014 23:36 Feb 15, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H533.IH H533 kjohnson on DSK79L0C42PROD with BILLS