Ensuring Parity in MA for Audio-Only Telehealth Act of 2021

II 117TH CONGRESS 1ST SESSION S. 150 To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the determination of risk adjustment for Medicare Advantage plans, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 2, 2021 Ms. CORTEZ MASTO (for herself and Mr. SCOTT of South Carolina) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to require the inclusion of certain audio-only diagnoses in the deter- mination of risk adjustment for Medicare Advantage plans, and for other purposes. 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 ‘‘Ensuring Parity in 4 MA for Audio-Only Telehealth Act of 2021’’. 5 VerDate Sep 11 2014 20:13 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S150.IS S150 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 150 IS SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO- 1 ONLY DIAGNOSES IN THE DETERMINATION 2 OF RISK ADJUSTMENT FOR MEDICARE AD- 3 VANTAGE PLANS. 4 Section 1853(a)(1) of the Social Security Act (42 5 U.S.C. 1395w–23(a)(1)) is amended by adding at the end 6 the following new subparagraph: 7 ‘‘(J) INCLUSION OF CERTAIN AUDIO-ONLY 8 DIAGNOSES FOR PURPOSES OF RISK ADJUST- 9 MENT.— 10 ‘‘(i) IN GENERAL.—For purposes of 11 determining the appropriate adjustment 12 for health status under subparagraph 13 (C)(i) for plan years 2020 and 2021 (and 14 for such other plan years determined ap- 15 propriate by the Secretary), the Secretary, 16 in determining the diseases or conditions 17 of an individual, shall take into account di- 18 agnoses obtained through a telehealth en- 19 counter, and in the case of a qualified di- 20 agnosis (as defined in clause (ii)) made 21 with respect to such individual by a quali- 22 fied provider (as so defined), shall not re- 23 quire the use of video communications with 24 respect to such telehealth encounter. 25 VerDate Sep 11 2014 20:13 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S150.IS S150 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 150 IS ‘‘(ii) DEFINITIONS.—For purposes of 1 this subparagraph: 2 ‘‘(I) QUALIFIED DIAGNOSIS.— 3 The term ‘qualified diagnosis’ means 4 a diagnosis made with respect to a 5 chronic disease or condition of an in- 6 dividual during a plan year if such di- 7 agnosis was also made with respect to 8 such individual in one of the last of 9 the 3 plan years preceding such plan 10 year. 11 ‘‘(II) QUALIFIED PROVIDER.— 12 The term ‘qualified provider’ means, 13 with respect to a qualified diagnosis 14 made with respect to an individual 15 during a plan year, a provider of serv- 16 ices, clinician or supplier that— 17 ‘‘(aa) furnished an item or 18 service to such individual during 19 the 3-year period ending on the 20 date such diagnosis was so made; 21 or 22 ‘‘(bb) is in the same practice 23 (as determined by tax identifica- 24 tion number) of a provider of 25 VerDate Sep 11 2014 20:13 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S150.IS S150 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 150 IS services or supplier who fur- 1 nished such an item or service to 2 such individual during such pe- 3 riod.’’. 4 SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS 5 DURING THE COVID–19 EMERGENCY. 6 Section 1834(m) of the Social Security Act (42 7 U.S.C. 1395m(m)) is amended by adding at the end the 8 following new paragraph: 9 ‘‘(9) SPECIAL RULE FOR TELEHEALTH PAY- 10 MENT PARITY DURING THE COVID–19 EMER- 11 GENCY.—In the case of a telehealth service fur- 12 nished during the emergency period described in sec- 13 tion 1135(g)(1)(B) for which payment may be made 14 under this subsection (including any service for 15 which payment may be so made due to application 16 of a waiver made under section 1135(b)), the 17 amount of such payment shall be equal to the 18 amount that would have been paid for such service 19 had such service been furnished in-person.’’. 20 Æ VerDate Sep 11 2014 20:13 Feb 14, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S150.IS S150 pamtmann on DSKBC07HB2PROD with BILLS