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

I 117TH CONGRESS 1ST SESSION H. R. 2166 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 PACE programs, and for other pur- poses. IN THE HOUSE OF REPRESENTATIVES MARCH 23, 2021 Ms. SEWELL (for herself, Mr. BILIRAKIS, Mr. CA´RDENAS, Mrs. WALORSKI, Mr. KIND, Mr. SMITH of Missouri, Ms. HOULAHAN, and Mr. FITZPATRICK) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on En- ergy and Commerce, 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 committee concerned 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 PACE programs, 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 and PACE for Audio-Only Telehealth Act of 2021’’. 5 VerDate Sep 11 2014 01:00 May 21, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 2166 IH SEC. 2. REQUIRING THE INCLUSION OF CERTAIN AUDIO- 1 ONLY DIAGNOSES IN THE DETERMINATION 2 OF RISK ADJUSTMENT FOR MEDICARE AD- 3 VANTAGE PLANS AND PACE PROGRAMS. 4 (a) IN GENERAL.—Section 1853(a)(1) of the Social 5 Security Act (42 U.S.C. 1395w–23(a)(1)) is amended by 6 adding at the end 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 01:00 May 21, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 2166 IH ‘‘(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 01:00 May 21, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 2166 IH services or supplier who fur- 1 nished such an item or service to 2 such individual during such pe- 3 riod.’’. 4 (b) PACE PROGRAM CONFORMING AMENDMENT.— 5 Section 1894(d)(2) of the Social Security Act (42 U.S.C. 6 1395eee(d)(2)) is amended by adding at the end the fol- 7 lowing new sentence: ‘‘For purposes of applying the ad- 8 justment under subparagraph (C)(i) of section 1853(a)(1) 9 to such amounts, subparagraph (J) of such section shall 10 be applied as if each reference to ‘plan year’ and ‘plan 11 years 2020 and 2021’ were instead a reference to ‘year’ 12 and ‘2020 and 2021’, respectively.’’. 13 SEC. 3. REQUIRING PARITY IN TELEHEALTH PAYMENTS 14 DURING THE COVID–19 EMERGENCY. 15 Section 1834(m) of the Social Security Act (42 16 U.S.C. 1395m(m)) is amended by adding at the end the 17 following new paragraph: 18 ‘‘(9) SPECIAL RULE FOR TELEHEALTH PAY- 19 MENT PARITY DURING THE COVID–19 EMER- 20 GENCY.—In the case of a telehealth service fur- 21 nished during the emergency period described in sec- 22 tion 1135(g)(1)(B) for which payment may be made 23 under this subsection (including any service for 24 which payment may be so made due to application 25 VerDate Sep 11 2014 01:00 May 21, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2166.IH H2166 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 2166 IH of a waiver made under section 1135(b)), the 1 amount of such payment shall be equal to the 2 amount that would have been paid for such service 3 had such service been furnished in-person.’’. 4 Æ VerDate Sep 11 2014 01:00 May 21, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H2166.IH H2166 pbinns on DSKJLVW7X2PROD with BILLS