Ensuring Coverage in Public Health Emergencies Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6317 To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 23, 2020 Mr. DOGGETT (for himself, Ms. DEGETTE, Ms. WILD, Mr. BRENDAN F. BOYLE of Pennsylvania, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. EVANS, Mr. CISNEROS, Mr. DEUTCH, Ms. VELA´ZQUEZ, Mr. PASCRELL, Mr. KHANNA, Ms. CASTOR of Florida, Mr. CASTRO of Texas, Mr. VARGAS, Mr. CONNOLLY, Mrs. HAYES, Mr. TRONE, Mr. LARSON of Con- necticut, Mr. BLUMENAUER, Mrs. FLETCHER, Mr. JOHNSON of Georgia, Ms. MOORE, Mr. ALLRED, Mr. CUELLAR, Ms. JOHNSON of Texas, Ms. SEWELL of Alabama, Ms. WASSERMAN SCHULTZ, Mr. KILDEE, Mr. MCGOVERN, Mr. LEWIS, Ms. GARCIA of Texas, Ms. MUCARSEL-POWELL, Mr. DANNY K. DAVIS of Illinois, Mr. NADLER, Ms. SHALALA, Mr. BEYER, Mr. SCHNEIDER, Mrs. NAPOLITANO, Mr. CRIST, Ms. SPANBERGER, Mr. SOTO, Mr. LAWSON of Florida, Ms. PORTER, Mr. RYAN, Mr. KENNEDY, Mr. NEGUSE, Ms. WILSON of Florida, Mrs. DIN- GELL, Mr. HASTINGS, Mr. COHEN, Mr. CLAY, Mr. CA´RDENAS, Ms. SCHA- KOWSKY, Mrs. TORRES of California, Ms. ESCOBAR, Mr. BUTTERFIELD, Mr. WELCH, Mr. SEAN PATRICK MALONEY of New York, Ms. PRESSLEY, Mr. SIRES, Ms. DAVIDS of Kansas, Ms. SPEIER, Ms. ADAMS, Mr. TED LIEU of California, Ms. KUSTER of New Hampshire, Ms. TORRES SMALL of New Mexico, Ms. DELAURO, Mr. COX of California, Mr. POCAN, Ms. PINGREE, and Ms. OMAR) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor, and Ways and Means, 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 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6317 IH A BILL To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, 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 Coverage in 4 Public Health Emergencies Act of 2020’’. 5 SEC. 2. SPECIAL ENROLLMENT PERIODS DURING PUBLIC 6 HEALTH EMERGENCIES. 7 (a) PUBLIC HEALTH SERVICE ACT.—Title XXVII of 8 the Public Health Service Act (42 U.S.C. 300gg et seq.) 9 is amended— 10 (1) in section 2702(b)(2) (42 U.S.C. 300gg– 11 1(b)(2)), by inserting ‘‘, which shall include a special 12 enrollment period of 30 days during a public health 13 emergency declared under section 319, which period 14 may be extended for such time as the Secretary may 15 require’’ before the period at the end; and 16 (2) in section 2704(f) (42 U.S.C. 300gg–3(f)), 17 by adding at the end the following: 18 ‘‘(4) PUBLIC HEALTH EMERGENCIES.—If the 19 Secretary declares a public health emergency under 20 section 319, a group health plan, and a group health 21 VerDate Sep 11 2014 22:12 Apr 10, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6317 IH insurance issuer offering group health insurance cov- 1 erage in connection with a group health plan, shall 2 permit an employee who is eligible, but not enrolled, 3 for coverage under the terms of the plan or coverage 4 (or a dependent of such an employee if the depend- 5 ent is eligible, but not enrolled, for coverage under 6 such terms) to enroll for coverage under the terms 7 of the plan or coverage during the special enrollment 8 period required under section 2702(b)(2) of the Pub- 9 lic Health Service Act (42 U.S.C. 300gg–1(b)(2)).’’. 10 (b) ERISA.—Section 701(f) of the Employee Retire- 11 ment Income Security Act of 1974 (29 U.S.C. 1181(f)) 12 is amended by adding at the end the following: 13 ‘‘(4) PUBLIC HEALTH EMERGENCIES.—If the 14 Secretary of Health and Human Services declares a 15 public health emergency under section 319 of the 16 Public Health Service Act (42 U.S.C. 247d), a 17 group health plan, or a health insurance issuer offer- 18 ing group health insurance coverage in connection 19 with such a plan, shall permit an employee who is 20 eligible, but not enrolled, for coverage under the 21 terms of the plan or coverage (or a dependent of 22 such an employee if the dependent is eligible, but 23 not enrolled, for coverage under such terms) to en- 24 roll for coverage under the terms of the plan or cov- 25 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6317 IH erage during the special enrollment period required 1 under section 2702(b)(2) of the Public Health Serv- 2 ice Act (42 U.S.C. 300gg–1(b)(2)).’’. 3 (c) IRC.—Section 9801(f) of the Internal Revenue 4 Code of 1986 (26 U.S.C. 9801(f)) is amended by adding 5 at the end the following new paragraph: 6 ‘‘(4) PUBLIC HEALTH EMERGENCIES.—If the 7 Secretary of Health and Human Services declares a 8 public health emergency under section 319 of the 9 Public Health Service Act (42 U.S.C. 247d), a 10 group health plan shall permit an employee who is 11 eligible, but not enrolled, for coverage under the 12 terms of the plan (or a dependent of such an em- 13 ployee if the dependent is eligible, but not enrolled, 14 for coverage under such terms) to enroll for coverage 15 under the terms of the plan during the special en- 16 rollment period required under section 2702(b)(2) of 17 the Public Health Service Act (42 U.S.C. 300gg– 18 1(b)(2)).’’. 19 (d) RULE OF CONSTRUCTION.—Nothing in the 20 amendments made by subsections (a) and (b) shall be con- 21 strued to prevent a group health plan or health insurance 22 issuer from offering a special enrollment period in addition 23 to any such period required under Federal law. 24 VerDate Sep 11 2014 22:12 Apr 10, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6317 IH SEC. 3. COVERAGE OF PREVENTION AND TREATMENT RE- 1 LATED TO PUBLIC HEALTH EMERGENCIES. 2 (a) REQUIRED COVERAGE.— 3 (1) IN GENERAL.—Subpart II of part A of title 4 XXVII of the Public Health Service Act (42 U.S.C. 5 300gg–11 et seq.) is amended by adding at the end 6 the following: 7 ‘‘SEC. 2729A. COVERAGE OF PREVENTION AND TREATMENT 8 RELATED TO PUBLIC HEALTH EMERGENCIES. 9 ‘‘(a) IN GENERAL.—A group health plan or a health 10 insurance issuer offering group or individual health insur- 11 ance coverage shall provide coverage for such services re- 12 lated to a disease or condition relating to a public health 13 emergency declared under section 319, which, as applica- 14 ble, shall include any services for the prevention or treat- 15 ment, of the disease or condition. 16 ‘‘(b) SCOPE OF BENEFITS.—The prevention and 17 treatment measures for which coverage is required under 18 subsection (a) shall— 19 ‘‘(1) be at the same level as benefits for the 20 prevention or treatment of other similar or related 21 diseases or conditions, if applicable, under the plan 22 or coverage; and 23 ‘‘(2) include, with respect to the disease or con- 24 dition reasonably related to the public health emer- 25 gency, even if no diagnosis has been made and even 26 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6317 IH if the enrollee ultimately is determined not to have 1 the disease or condition, as applicable— 2 ‘‘(A) vaccines to prevent the disease or 3 condition, if applicable; 4 ‘‘(B) testing for diagnosis of the disease or 5 condition, if applicable; 6 ‘‘(C) care related to symptoms an enrollee 7 may experience; and 8 ‘‘(D) treatments for the disease or condi- 9 tion. 10 ‘‘(c) COST-SHARING.—Cost-sharing for services for 11 which coverage is required under subsection (a) shall be 12 comparable to similar such services that would be covered 13 by the plan or coverage outside of a public health emer- 14 gency. 15 ‘‘(d) WAIVER OF RESTRICTIONS.— 16 ‘‘(1) IN GENERAL.—A group health plan or 17 health insurance issuer offering group or individual 18 health insurance coverage shall waive any restriction 19 (including any prior authorization requirement, limi- 20 tation on filling or refilling prescription drugs, or 21 other restrictions) on access to covered benefits re- 22 quired under this section, if the service is deter- 23 mined by a qualified health professional to be medi- 24 cally necessary by the provider and the Secretary de- 25 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6317 IH termines such restriction to be unduly burdensome 1 in the context of the applicable public health emer- 2 gency. 3 ‘‘(2) TERM OF WAIVER.—Any waiver of restric- 4 tions pursuant to paragraph (1) shall apply only for 5 the duration of the public health emergency, as de- 6 clared under section 319.’’. 7 (2) ERISA.— 8 (A) IN GENERAL.—Subpart B of part 7 of 9 subtitle B of title I of the Employee Retirement 10 Income Security Act of 1974 (29 U.S.C. 1181 11 et seq.) is amended by adding at the end the 12 following: 13 ‘‘SEC. 716. COVERAGE OF PREVENTION AND TREATMENT 14 RELATED TO PUBLIC HEALTH EMERGENCIES. 15 ‘‘(a) IN GENERAL.—A group health plan or a health 16 insurance issuer offering group health insurance coverage, 17 shall provide coverage for such services related to a disease 18 or condition relating to a public health emergency declared 19 under section 319 of the Public Health Service Act, which, 20 as applicable, shall include any services for the prevention 21 or treatment, of the disease or condition. 22 ‘‘(b) SCOPE OF BENEFITS.—The prevention and 23 treatment measures for which coverage is required under 24 subsection (a) shall— 25 VerDate Sep 11 2014 22:12 Apr 10, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 6317 IH ‘‘(1) be at the same level as benefits for the 1 prevention or treatment of other similar or related 2 diseases or conditions, if applicable, under the plan 3 or coverage; and 4 ‘‘(2) include, with respect to the disease or con- 5 dition reasonably related to the public health emer- 6 gency, even if no diagnosis has been made and even 7 if the enrollee ultimately is determined not to have 8 the disease or condition, as applicable— 9 ‘‘(A) vaccines to prevent the disease or 10 condition, if applicable; 11 ‘‘(B) testing for diagnosis of the disease or 12 condition, if applicable; 13 ‘‘(C) care related to symptoms an enrollee 14 may experience; and 15 ‘‘(D) treatments for the disease or condi- 16 tion. 17 ‘‘(c) COST-SHARING.—Cost-sharing for services for 18 which coverage is required under subsection (a) shall be 19 comparable to similar such services that would be covered 20 by the plan or coverage outside of a public health emer- 21 gency. 22 ‘‘(d) WAIVER OF RESTRICTIONS.— 23 ‘‘(1) IN GENERAL.—A group health plan or 24 health insurance issuer offering group health insur- 25 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 6317 IH ance coverage shall waive any restriction (including 1 any prior authorization requirement, limitation on 2 filling or refilling prescription drugs, or other re- 3 strictions) on access to covered benefits required 4 under this section, if the service is determined by a 5 qualified health professional to be medically nec- 6 essary by the provider and the Secretary determines 7 such restriction to be unduly burdensome in the con- 8 text of the applicable public health emergency. 9 ‘‘(2) TERM OF WAIVER.—Any waiver of restric- 10 tions pursuant to paragraph (1) shall apply only for 11 the duration of the public health emergency, as de- 12 clared under section 319 of the Public Health Serv- 13 ice Act.’’. 14 (B) CLERICAL AMENDMENT.—The table of 15 sections for subpart B of part 7 of subtitle B 16 of title I of the Employee Retirement Income 17 Security Act of 1974 is amended by adding at 18 the end the following: 19 ‘‘Sec. 715. Additional market reforms. ‘‘Sec. 716. Coverage of prevention and treatment related to public health emer- gencies.’’. (3) IRC.— 20 (A) IN GENERAL.—Subchapter B of chap- 21 ter 100 of the Internal Revenue Code of 1986 22 is amended by adding at the end the following 23 new section: 24 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 6317 IH ‘‘SEC. 9816. COVERAGE OF PREVENTION AND TREATMENT 1 RELATED TO PUBLIC HEALTH EMERGENCIES. 2 ‘‘(a) IN GENERAL.—A group health plan shall pro- 3 vide coverage for such services related to a disease or con- 4 dition relating to a public health emergency declared 5 under section 319 of the Public Health Service Act, which, 6 as applicable, shall include any services for the prevention 7 or treatment, of the disease or condition. 8 ‘‘(b) SCOPE OF BENEFITS.—The prevention and 9 treatment measures for which coverage is required under 10 subsection (a) shall— 11 ‘‘(1) be at the same level as benefits for the 12 prevention or treatment of other similar or related 13 diseases or conditions, if applicable, under the plan; 14 and 15 ‘‘(2) include, with respect to the disease or con- 16 dition reasonably related to the public health emer- 17 gency, even if no diagnosis has been made and even 18 if the enrollee ultimately is determined not to have 19 the disease or condition, as applicable— 20 ‘‘(A) vaccines to prevent the disease or 21 condition, if applicable; 22 ‘‘(B) testing for diagnosis of the disease or 23 condition, if applicable; 24 ‘‘(C) care related to symptoms an enrollee 25 may experience; and 26 VerDate Sep 11 2014 02:01 Apr 07, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6317.IH H6317 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 6317 IH ‘‘(D) treatments for the disease or condi- 1 tion. 2 ‘‘(c) COST-SHARING.—Cost-sharing for services for 3 which coverage is required under subsection (a) shall be 4 comparable to similar such services that would be covered 5 by the plan outside of a public health emergency. 6 ‘‘(d) WAIVER OF RESTRICTIONS.— 7 ‘‘(1) IN GENERAL.—A group health plan shall 8 waive any restriction (including any prior authoriza- 9 tion requirement, limitation on filling or refilling 10 prescription drugs, or other restri [Text truncated for display. 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