Care for COVID–19 Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 898 To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage without any cost sharing for certain items and services furnished during any portion of such emergency period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES FEBRUARY 5, 2021 Mr. RUIZ (for himself and Ms. UNDERWOOD) 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 jurisdic- tion of the committee concerned A BILL To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage without any cost sharing for certain items and services furnished during any portion of such emergency period, 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 ‘‘Care for COVID–19 4 Act of 2021’’. 5 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 898 IH SEC. 2. COVERAGE OF COVID–19 RELATED TREATMENT AT 1 NO COST SHARING. 2 (a) IN GENERAL.—A group health plan and a health 3 insurance issuer offering group or individual health insur- 4 ance coverage (including a grandfathered health plan (as 5 defined in section 1251(e) of the Patient Protection and 6 Affordable Care Act)) shall provide coverage, and shall not 7 impose any cost sharing (including deductibles, copay- 8 ments, and coinsurance) requirements, for the following 9 items and services furnished during any portion of the 10 emergency period defined in paragraph (1)(B) of section 11 1135(g) of the Social Security Act (42 U.S.C. 1320b– 12 5(g)) beginning on or after the date of the enactment of 13 this Act: 14 (1) Medically necessary items and services (in- 15 cluding in-person or telehealth visits in which such 16 items and services are furnished) that are furnished 17 to an individual who has been diagnosed with (or 18 after provision of the items and services is diagnosed 19 with) COVID–19 to treat or mitigate the effects of 20 COVID–19. 21 (2) Medically necessary items and services (in- 22 cluding in-person or telehealth visits in which such 23 items and services are furnished) that are furnished 24 to an individual who is presumed to have COVID– 25 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 898 IH 19 but is never diagnosed as such, if the following 1 conditions are met: 2 (A) Such items and services are furnished 3 to the individual to treat or mitigate the effects 4 of COVID–19 or to mitigate the impact of 5 COVID–19 on society. 6 (B) Health care providers have taken ap- 7 propriate steps under the circumstances to 8 make a diagnosis, or confirm whether a diag- 9 nosis was made, with respect to such individual, 10 for COVID–19, if possible. 11 (b) ITEMS AND SERVICES RELATED TO COVID– 12 19.—For purposes of this section— 13 (1) not later than one week after the date of 14 the enactment of this section, the Secretary of 15 Health and Human Services, Secretary of Labor, 16 and Secretary of the Treasury shall jointly issue 17 guidance specifying applicable diagnoses and medi- 18 cally necessary items and services related to 19 COVID–19; and 20 (2) such items and services shall include all 21 items or services that are relevant to the treatment 22 or mitigation of COVID–19, regardless of whether 23 such items or services are ordinarily covered under 24 the terms of a group health plan or group or indi- 25 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 898 IH vidual health insurance coverage offered by a health 1 insurance issuer. 2 (c) REIMBURSEMENT TO PLANS AND COVERAGE FOR 3 WAIVING COST SHARING.— 4 (1) IN GENERAL.—A group health plan or a 5 health insurance issuer offering group or individual 6 health insurance coverage (including a grandfathered 7 health plan (as defined in section 1251(e) of the Pa- 8 tient Protection and Affordable Care Act)) that does 9 not impose cost sharing requirements as described in 10 subsection (a) shall notify the Secretary of Health 11 and Human Services, Secretary of Labor, and Sec- 12 retary of the Treasury (through a joint process es- 13 tablished jointly by the Secretaries) of the total dol- 14 lar amount of cost sharing that, but for the applica- 15 tion of subsection (a), would have been required 16 under such plans and coverage for items and serv- 17 ices related to COVID–19 furnished during the pe- 18 riod to which subsection (a) applies to enrollees, par- 19 ticipants, and beneficiaries in the plan or coverage to 20 whom such subsection applies, but which was not 21 imposed for such items and services so furnished 22 pursuant to such subsection and the Secretary of 23 Health and Human Services, in coordination with 24 the Secretary of Labor and the Secretary of the 25 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 898 IH Treasury, shall make payments in accordance with 1 this subsection to the plan or issuer equal to such 2 total dollar amount. 3 (2) METHODOLOGY FOR PAYMENTS.—The Sec- 4 retary of Health and Human Services, in coordina- 5 tion with the Secretary of Labor and the Secretary 6 of the Treasury shall establish a payment system for 7 making payments under this subsection. Any such 8 system shall make payment for the value of cost 9 sharing not imposed by the plan or issuer involved. 10 (3) TIMING OF PAYMENTS.—Payments made 11 under paragraph (1) shall be made no later than 12 May 1, 2022, for amounts of cost sharing waivers 13 with respect to 2021. Payments under this sub- 14 section with respect to such waivers with respect to 15 a year subsequent to 2021 that begins during the 16 period to which subsection (a) applies shall be made 17 no later than May of the year following such subse- 18 quent year. 19 (4) APPROPRIATIONS.—There is authorized to 20 be appropriated, and there is appropriated, out of 21 any monies in the Treasury not otherwise appro- 22 priated, such funds as are necessary to carry out 23 this subsection. 24 (d) ENFORCEMENT.— 25 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 898 IH (1) APPLICATION WITH RESPECT TO PHSA, 1 ERISA, AND IRC.—The provisions of this section 2 shall be applied by the Secretary of Health and 3 Human Services, Secretary of Labor, and Secretary 4 of the Treasury to group health plans and health in- 5 surance issuers offering group or individual health 6 insurance coverage as if included in the provisions of 7 part A of title XXVII of the Public Health Service 8 Act, part 7 of the Employee Retirement Income Se- 9 curity Act of 1974, and subchapter B of chapter 100 10 of the Internal Revenue Code of 1986, as applicable. 11 (2) PRIVATE RIGHT OF ACTION.—An individual 12 with respect to whom an action is taken by a group 13 health plan or health insurance issuer offering group 14 or individual health insurance coverage in violation 15 of subsection (a) may commence a civil action 16 against the plan or issuer for appropriate relief. The 17 previous sentence shall not be construed as limiting 18 any enforcement mechanism otherwise applicable 19 pursuant to paragraph (1). 20 (e) IMPLEMENTATION.—The Secretary of Health and 21 Human Services, Secretary of Labor, and Secretary of the 22 Treasury may implement the provisions of this section 23 through sub-regulatory guidance, program instruction, or 24 otherwise. 25 VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 898 IH (f) TERMS.—The terms ‘‘group health plan’’, ‘‘health 1 insurance issuer’’, ‘‘group health insurance coverage’’, and 2 ‘‘individual health insurance coverage’’ have the meanings 3 given such terms in section 2791 of the Public Health 4 Service Act (42 U.S.C. 300gg–91), section 733 of the Em- 5 ployee Retirement Income Security Act of 1974 (29 6 U.S.C. 1191b), and section 9832 of the Internal Revenue 7 Code of 1986, as applicable. 8 Æ VerDate Sep 11 2014 00:02 Feb 26, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H898.IH H898 pamtmann on DSKBC07HB2PROD with BILLS