Coverage for COVID–19 Treatment Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6568 To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage without im- posing any cost sharing requirements for certain items and services furnished during any portion of the COVID–19 emergency period, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 21, 2020 Ms. BLUNT ROCHESTER (for herself, Mrs. TRAHAN, and Mr. PASCRELL) in- troduced the following bill; which was referred to the Committee on En- ergy and Commerce, and in addition to the Committees on Ways and Means, and Education and Labor, for a period to be subsequently deter- mined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction 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 imposing any cost sharing requirements for certain items and services furnished during any portion of the COVID–19 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 VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6568 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Coverage for COVID– 2 19 Treatment Act of 2020’’. 3 SEC. 2. COVERAGE OF COVID-19 RELATED TREATMENT AT 4 NO COST SHARING. 5 (a) IN GENERAL.—A group health plan and a health 6 insurance issuer offering group or individual health insur- 7 ance coverage (including a grandfathered health plan (as 8 defined in section 1251(e) of the Patient Protection and 9 Affordable Care Act)) shall provide coverage, and shall not 10 impose any cost sharing (including deductibles, copay- 11 ments, and coinsurance) requirements, for the following 12 items and services furnished during any portion of the 13 emergency period defined in paragraph (1)(B) of section 14 1135(g) of the Social Security Act (42 U.S.C. 1320b– 15 5(g)) beginning on or after the date of the enactment of 16 this Act: 17 (1) Medically necessary items and services (in- 18 cluding in-person or telehealth visits in which such 19 items and services are furnished) that are furnished 20 to an individual who has been diagnosed with (or 21 after provision of the items and services is diagnosed 22 with) COVID-19 to treat or mitigate the effects of 23 COVID-19. 24 (2) Medically necessary items and services (in- 25 cluding in-person or telehealth visits in which such 26 VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6568 IH items and services are furnished) that are furnished 1 to an individual who is presumed to have COVID- 2 19 but is never diagnosed as such, if the following 3 conditions are met: 4 (A) Such items and services are furnished 5 to the individual to treat or mitigate the effects 6 of COVID-19 or to mitigate the impact of 7 COVID-19 on society. 8 (B) Health care providers have taken ap- 9 propriate steps under the circumstances to 10 make a diagnosis, or confirm whether a diag- 11 nosis was made, with respect to such individual, 12 for COVID-19, if possible. 13 (b) ITEMS AND SERVICES RELATED TO COVID- 14 19.—For purposes of this section— 15 (1) not later than one week after the date of 16 the enactment of this section, the Secretary of 17 Health and Human Services, Secretary of Labor, 18 and Secretary of the Treasury shall jointly issue 19 guidance specifying applicable diagnoses and medi- 20 cally necessary items and services related to COVID- 21 19; and 22 (2) such items and services shall include all 23 items or services that are relevant to the treatment 24 or mitigation of COVID-19, regardless of whether 25 VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6568 IH such items or services are ordinarily covered under 1 the terms of a group health plan or group or indi- 2 vidual health insurance coverage offered by a health 3 insurance issuer. 4 (c) REIMBURSEMENT TO PLANS AND COVERAGE FOR 5 WAIVING COST SHARING.— 6 (1) IN GENERAL.—A group health plan or a 7 health insurance issuer offering group or individual 8 health insurance coverage (including a grandfathered 9 health plan (as defined in section 1251(e) of the Pa- 10 tient Protection and Affordable Care Act)) that does 11 not impose cost sharing requirements as described in 12 subsection (a) shall notify the Secretary of Health 13 and Human Services, Secretary of Labor, and Sec- 14 retary of the Treasury (through a joint process es- 15 tablished jointly by the Secretaries) of the total dol- 16 lar amount of cost sharing that, but for the applica- 17 tion of subsection (a), would have been required 18 under such plans and coverage for items and serv- 19 ices related to COVID-19 furnished during the pe- 20 riod to which subsection (a) applies to enrollees, par- 21 ticipants, and beneficiaries in the plan or coverage to 22 whom such subsection applies, but which was not 23 imposed for such items and services so furnished 24 pursuant to such subsection and the Secretary of 25 VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6568 IH Health and Human Services, in coordination with 1 the Secretary of Labor and the Secretary of the 2 Treasury, shall make payments in accordance with 3 this subsection to the plan or issuer equal to such 4 total dollar amount. 5 (2) METHODOLOGY FOR PAYMENTS.—The Sec- 6 retary of Health and Human Services, in coordina- 7 tion with the Secretary of Labor and the Secretary 8 of the Treasury shall establish a payment system for 9 making payments under this subsection. Any such 10 system shall make payment for the value of cost 11 sharing not imposed by the plan or issuer involved. 12 (3) TIMING OF PAYMENTS.—Payments made 13 under paragraph (1) shall be made no later than 14 May 1, 2021, for amounts of cost sharing waivers 15 with respect to 2020. Payments under this sub- 16 section with respect to such waivers with respect to 17 a year subsequent to 2020 that begins during the 18 period to which subsection (a) applies shall be made 19 no later than May of the year following such subse- 20 quent year. 21 (4) APPROPRIATIONS.—There is authorized to 22 be appropriated, and there is appropriated, out of 23 any monies in the Treasury not otherwise appro- 24 VerDate Sep 11 2014 22:05 Apr 24, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6568 IH priated, such funds as are necessary to carry out 1 this subsection. 2 (d) ENFORCEMENT.— 3 (1) APPLICATION WITH RESPECT TO PHSA, 4 ERISA, AND IRC.—The provisions of this section 5 shall be applied by the Secretary of Health and 6 Human Services, Secretary of Labor, and Secretary 7 of the Treasury to group health plans and health in- 8 surance issuers offering group or individual health 9 insurance coverage as if included in the provisions of 10 part A of title XXVII of the Public Health Service 11 Act, part 7 of the Employee Retirement Income Se- 12 curity Act of 1974, and subchapter B of chapter 100 13 of the Internal Revenue Code of 1986, as applicable. 14 (2) PRIVATE RIGHT OF ACTION.—An individual 15 with respect to whom an action is taken by a group 16 health plan or health insurance issuer offering group 17 or individual health insurance coverage in violation 18 of subsection (a) may commence a civil action 19 against the plan or issuer for appropriate relief. The 20 previous sentence shall not be construed as limiting 21 any enforcement mechanism otherwise applicable 22 pursuant to paragraph (1). 23 (e) IMPLEMENTATION.—The Secretary of Health and 24 Human Services, Secretary of Labor, and Secretary of the 25 VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6568 IH Treasury may implement the provisions of this section 1 through sub-regulatory guidance, program instruction or 2 otherwise. 3 (f) TERMS.—The terms ‘‘group health plan’’, ‘‘health 4 insurance issuer’’, ‘‘group health insurance coverage’’, and 5 ‘‘individual health insurance coverage’’ have the meanings 6 given such terms in section 2791 of the Public Health 7 Service Act (42 U.S.C. 300gg–91), section 733 of the Em- 8 ployee Retirement Income Security Act of 1974 (29 9 U.S.C. 1191b), and section 9832 of the Internal Revenue 10 Code of 1986, as applicable. 11 Æ VerDate Sep 11 2014 19:18 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H6568.IH H6568 pamtmann on DSKBC07HB2PROD with BILLS